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A 59 year-old woman with metastatic breast cancer and a history of pulmonary embolism presented with symptoms of fatigue, lethargy, tachycardia and fever. CXR showed LLL opacity, LUL opacity and hilar fullness on the right with prominent bronchi (?cuffing) and vertebral fractures. She was admitted with bacteremia on 7/0/2006 and treated with whole brain radiotherapy in March 2006 and with weekly Taxol. Restaging studies showed stable visceral disease but progression of bony metastatic disease, so in January 2006, she initiated a second-line Navelbine therapy. At the ER, she was administered 1UPRBC, 1L NS, Levofloxacin 500 mg IV, and placed CVP~20. Her blood pressure systolic initially 120s but decreased to 90s (MAPS>70), and norepinephrine was administered. She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN Pain, Temperature greater than:101, Other:transfusion premedication, ALBUTEROL NEBULIZER 2.5 MG INH Q4H PRN Wheezing, TESSALON PERLES (BENZONATATE) 100 MG PO TID PRN Other:congestion, BENADRYL (DIPHENHYDRAMINE) 12.5 MG PO x1 PRN Other:pre-transfusion, COLACE (DOCUSATE SODIUM) 100 MG PO BID PRN Constipation, ENOXAPARIN 40 MG SC DAILY, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, FLOVENT HFA (FLUTICASONE PROPIONATE) 110 MCG INH BID, INSULIN ASPART Sliding Scale. | Has the patient taken any medications for bs is 351-400 management | {
"answer_end": [
1280
],
"answer_start": [
1252
],
"text": [
"INSULIN ASPART Sliding Scale"
]
} |
76 year-old male with significant cardiac history, including NSTEMI and asystole arrest, presented with weakness, dizziness, and chest pain for 3 days, currently chest pain-free. EKG on admission showed subtle changes with <1 mm ST depression in lateral leads. Patient was given Acetylsalicylic Acid 325 mg PO QD, Ativan 0.5 mg x 1, Magnesium Chloride 500 mg x 1, Atenolol 25 mg PO QD, Atorvastatin 80 mg PO QD, Docusate Sodium 100 mg PO BID, Losartan 50 mg PO QD, Amlodipine 10 mg PO QD, Pantoprazole 40 mg PO QD, Lipitor (Atorvastatin) 80 mg PO daily, Colace (Docusate Sodium) 100 mg PO BID, Potassium Chloride IV, Potassium Chloride Immediate Release PO, Magnesium Gluconate (Magnesium Gluconate) 400 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, ASA 325 mg x 1, and MIBI ordered. Metformin was held and DM protocol was instituted while in house. Patient was at risk for cardiac event and was treated with BB and titrated as tolerated, with Tele monitoring. Nutrition consult was ordered due to recent decrease in appetite and FTT picture. SW was consulted and patient was discussed at length for services at home when discharged. Patient left AMA despite lengthy discussion about his health and risk for MI/death. Number of Doses Required (approximate): 3 for MG GLUCONATE (MAGNESIUM GLUCONATE) and 2 for TERAZOSIN HCL 1 MG PO DAILY. Home meds included ASA 325 mg daily, lipitor 80 mg daily, amlodipine 5 mg daily, protonix 40 mg daily, losartan 50 mg daily, and terazosin 1 mg daily. An override was added on 7/10/07 by KETCHAM, JAKE WALDO, M.D., PH.D. on order for KCL IV (ref # 687673059) with POTENTIALLY SERIOUS INTERACTION: LOSARTAN POTASSIUM & POTASSIUM CHLORIDE Reason for override: md aware, and on 11/8/07 by DERNIER, AUGUSTINE A., P.A.-C. on order for KCL IMMEDIATE RELEASE PO (ref # 856712835) with the same POTENTIALLY SERIOUS INTERACTION. Patient was instructed to resume regular exercise and to avoid grapefruit unless instructed otherwise. He was also given a diet of House/2gm Na/Carbohydrate Controlled/Low saturated fat low cholesterol. | Why has the patient been prescribed bb | {
"answer_end": [
945
],
"answer_start": [
857
],
"text": [
"Patient was at risk for cardiac event and was treated with BB and titrated as tolerated,"
]
} |
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. | What medications did the patient take for blood sugars 201-250 | {
"answer_end": [
2497
],
"answer_start": [
2434
],
"text": [
"human insulin sliding scale: for blood sugars 151-200 give 4 U,"
]
} |
Ms. Fought is a 50-year-old female with a history of bipolar disorder, schizophrenia, obstructive sleep apnea, hypertension, and diabetes who presented with right knee swelling, redness, and pain and was admitted to the Emergency Department. She was given therapeutic doses of heparin because of the concern of pain, as well as IV fluids, Oxycodone 5 mg to 10 mg p.o. q.4h. p.r.n. pain, Tylenol 650 mg p.o. q.4h. p.r.n. pain, Ibuprofen 600 mg q.6h. p.r.n. pain, Klonopin 1 mg p.o. at bedtime, Levofloxacin 500 mg p.o. daily for six days after the day of discharge, and NSAIDs, and was prescribed Lisinopril 10 mg daily, Lipitor 40 mg daily, Klonopin, MetroGel p.o. at bedtime, Lithium 900 mg at bedtime, Acebutolol 200 mg daily, and Risperdal 0.5 mg at bedtime, with no known drug allergies. She responded well to normal saline fluid boluses for a total of 3 liters over her hospital course, and was treated with Unasyn and vancomycin, and then switched to levofloxacin, with six more days after discharge from the hospital. Her bradycardia was resolved either over beta blockade or lithium toxicity, for which her beta-blocker was held and her lithium was also held, resulting in an improved heart rate in the 50s and 60s. Upon discharge, she was given instructions to draw blood for lithium level checks daily until it is below 0.5, at which time, she should be restarted on lithium 300 mg p.o. at bedtime, and to follow up with her primary care physician, Dr. Aurelio Gilberto Hencheck at Li County Hospital. | What swelling medications have ever been prescribed for pt. in the VA or mentioned in the record | {
"answer_end": [
316
],
"answer_start": [
242
],
"text": [
"She was given therapeutic doses of heparin because of the concern of pain,"
]
} |
The patient is a 42-year-old white man who presented with complaints of fever to 103 and chills, a productive cough, and groin pain lasting three days. At age three, he was diagnosed with Wilms' tumor on the left, which was resected and subsequently treated with wide field radiation, after which he developed radiation-induced tyroid cancer, at which time he underwent subtotal thyroidectomy. In May of 1997, he underwent living related donor renal transplantation for chronic renal failure, however, the postoperative course was complicated by cytomegalovirus infection, presenting with diarrhea and requiring hospitalization in February 1997. He was treated with ganciclovir and subsequently maintained on Cytovene. He had one fever spike on hospital day one and Levaquin was initiated on hospital day three along with intravenous antibiotics, after which he was switched to oral antibiotics, including Levaquin and Augmentin. His blood pressures were stabilized at 130/80 with the initiation of a second antihypertensive medication, Nifedipine XL, for which he was maintained for two days at 30 mg. Hematologic studies revealed that he was continued on anticoagulation for atrial fibrillation at 4 mg daily with an INR remaining in his goal parameters. His creatinine level was 2.5 and his cyclosporine level was 303 on admission, reaching a maximum of 19.8 on hospital day four. Endocrine studies revealed a TSH of 0.02, a T4 of 6.0, and a THPR of 1.47. The patient's pulmonary status improved on oxygen and on intravenous antibiotics, and all studies for atypical organisms were negative. Prior to discharge, the patient's pulmonary status had returned to baseline and had entirely resolved. The patient was discharged on Augmentin 250/125 mg t.i.d., Levaquin 250 mg q.d., CellCept 500 mg b.i.d., Neoral 100 mg b.i.d., Prednisone 10 mg q.d., Synthroid 125 mcg q.d., INP insulin 14 units subcu q.a.m., regular insulin subcu p.r.n., Axid 150 mg q.d., nadolol 80 mg q.d., nifedipine XL 30 mg q.d., Coumadin 4 mg q.d., and iron sulfate 300 mg q.d., and follow-up was scheduled for bone densitometry in July 1998, with Dr. Clinton Ardizone in January 1998, and with Dr. Win in March. | Has this patient ever tried synthroid | {
"answer_end": [
1906
],
"answer_start": [
1848
],
"text": [
"Synthroid 125 mcg q.d., INP insulin 14 units subcu q.a.m.,"
]
} |
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. | nifedipine | {
"answer_end": [
555
],
"answer_start": [
540
],
"text": [
"and nifedipine,"
]
} |
Mr. Klaja is an 81-year-old gentleman who presented with abdominal pain and diarrhea, and an abdominal CT revealed an infectious inflammatory bowel process. Stool samples were sent for C. diff toxin and assay, all were negative, while stool cultures did not grow anything out. Empiric treatment with p.o. vancomycin was started, and the patient's abdominal pain resolved and he was afebrile by discharge. A flexible sigmoidoscopy showed colitis consistent with inflammatory etiology, and the patient was discharged with a presumed C. diff colitis diagnosis on a 2-week course of vancomycin. The patient had a DVT followed by bacteremia with multi-resistant Klebsiella pneumoniae, treated with meropenem for 14 days with the course. The patient had no evidence of acute coronary syndrome on admission, and his coronary artery disease, CHF, and chronic kidney disease were managed with MEDICATIONS: aspirin 81 mg, Plavix 75 mg, Coumadin 5 mg, digoxin 0.125 mg, Lasix 49 mg daily, lisinopril 10 mg daily, Lopressor 25 mg b.i.d., Zocor 80 mg daily, Flomax 0.4 mg daily and Flovent 110 mcg b.i.d., lactobacillus p.o. for probiotics and patient also had flex sig 2-week course p.o. vancomycin alone. He was given gentle hydration therapy with 2 liters of IV fluids, and restarted on Lasix 40 mg p.o. daily for diuresis. He was also discharged on a course of lactobacillus p.o. for probiotics, with DISCHARGE MEDICATIONS: Included aspirin 81 mg p.o. daily, Plavix 75 mg p.o. daily, digoxin 0.125 mg p.o. daily, Nexium 20 mg p.o. daily, lactobacillus 2 tabs p.o. t.i.d., metoprolol 25 mg p.o. b.i.d., simvastatin 80 mg p.o. at bed time, Flomax 0.4 mg p.o. every evening, vancomycin 250 mg p.o. every 6 hours x8 days at supertherapeutic, Coumadin 6 mg p.o. daily, Flovent 110 mcg inhale b.i.d., Lasix 40 mg p.o. daily, his daily dose at home. | has there been a prior lasix | {
"answer_end": [
977
],
"answer_start": [
959
],
"text": [
"Lasix 49 mg daily,"
]
} |
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 this patient ever tried nitroglycerin 1/150th | {
"answer_end": [
411
],
"answer_start": [
335
],
"text": [
"The patient was given three sublingual Nitroglycerins after her primary M.D."
]
} |
This is a 61-year-old gentleman with severe pulmonary hypertension secondary to chronic PEs, OSA, gout, bilateral hip replacements who presents with two falls in the past two days. He was compliant with his medication regimen and denies dietary indiscretion. He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5, initially being supertherapeutic with a daily goal of negative 500 to 1 L with IV Lasix once or twice a day as needed, his home dose being 160 mg p.o. His baseline room air oxygen saturation was 90-93% and he should use oxygen as treatment for his pulmonary hypertension and be provided with oxygen at home. He was treated for his hip pain initially with oxycodone which was changed to Dilaudid for better pain control, and he should be changed back to his home dose of oxycodone when discharged. He also has a history of gout which was exacerbated with diuresis and he is on his home doses of allopurinol and colchicine, Indocin being added and he should receive a total of three days of Indocin. Tylenol and narcotics as previously described can be used to help with his gouty pain. His GI regimen includes Nexium at home and Prilosec while an inpatient, and he should be switched back to Nexium when discharged from rehabilitation. His lab results on discharge include a creatinine of 1, hematocrit of 53.1 and INR of 2.3, potassium being 3.9 and magnesium being 2.0. The discharge medications include Coumadin 11 mg on Monday, Wednesday and Friday and 12 mg the other days of the week, Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day, hydrochlorothiazide 25 once a day, Lasix 160 IV once per day, allopurinol 200 once per day, colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain, Tylenol 500-1000 mg p.o. q.6 h. p.r.n. pain not to exceed 4 gm total from all sources in a 24-hour period, Ambien 10 mg p.o. nightly p.r.n. insomnia. He is being discharged to rehab with a followup with his cardiologist, Dr. Insco, and an appointment with Endocrinology. | How much nifedipine extended release does the patient take per day | {
"answer_end": [
1672
],
"answer_start": [
1576
],
"text": [
"Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day,"
]
} |
Mr. Serafine is a 78-year-old gentleman with class III heart failure and aortic stenosis. He was admitted to the Intensive Care Unit on 3 mcg of epinephrine and insulin and Precedex. He was prescribed Atenolol 12.5 mg daily, aspirin 325 mg daily, metformin 500 mg b.i.d., and Humalog insulin 12 units q.i.d., intravenous Lasix but had weaned Lasix drip and had intermittent boluses of 40 mg IV to promote diuresis with good result. He was also found to have a positive urinary tract infection and was started on ciprofloxacin for a total of five days. The patient at one point required 5 liters of nasal cannula to get his saturations in the 90s. He was prescribed three days, Motrin 400 mg q.8h. p.r.n. pain, NovoLog 24 units subq q.a.c., Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily, patient was also discharged on NovoLog sliding scale subcutaneous q.a.c. with doses of Lasix 40 mg b.i.d., baby aspirin 81 mg daily, and potassium chloride slow release 20 mEq b.i.d. for three days. He was then discharged to home in stable condition with visiting nurse and medications including Atenolol 12.5 mg daily, aspirin 325 mg daily, metformin 500 mg b.i.d., and Humalog insulin 12 units q.i.d., Ciprofloxacin 500 mg q.6h. for remaining four doses, baby aspirin 81 mg daily, Lasix 40 mg b.i.d., for three days along with potassium chloride slow release 20 mEq b.i.d. for three days, Motrin 400 mg q.8h. p.r.n. pain, NovoLog 24 units subq q.a.c., Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily, and NovoLog sliding scale subcutaneous q.a.c. His beta-blocker was increased with good result and he underwent a minimally invasive aortic valve replacement with a 25-mm Carpentier-Edwards pericardial valve. He was then to follow up with Dr. Collin Hyman in six weeks and his cardiologist Dr. Louie W Eilders in one week. | What is the patient's current dose does the patient take of her humalog insulin | {
"answer_end": [
308
],
"answer_start": [
276
],
"text": [
"Humalog insulin 12 units q.i.d.,"
]
} |
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone | Has the patient ever been on loratidine | {
"answer_end": [
2109
],
"answer_start": [
2012
],
"text": [
"Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h,"
]
} |
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. | Has the patient taken medication for anticoagulation | {
"answer_end": [
578
],
"answer_start": [
525
],
"text": [
"heparin while starting anticoagulation with Coumadin."
]
} |
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. | What was the indication for my patient's coumadin | {
"answer_end": [
592
],
"answer_start": [
530
],
"text": [
"subacute thalamic stroke noted on CT 1/29, Afib - on COUMADIN,"
]
} |
Mr. Slunaker is a 56-year-old gentleman who underwent coronary artery bypass grafting x4 and was discharged to home in stable condition on 10/20/06. He presented to see Dr. Emory Bebeau in clinic with a warm and swollen left lower leg with redness and was placed on levofloxacin and vancomycin and had him admitted for left lower leg cellulitis. On admission, he was taking Toprol 25 mg daily, diltiazem 30 mg t.i.d., aspirin 325 mg daily, Lasix 40 mg daily, atorvastatin 40 mg daily, Tricor 145 mg daily, Zetia 10 mg daily, metformin 500 mg daily and potassium chloride slow release 20 mEq daily. Infectious disease was consulted and recommended discontinuing the vancomycin and levofloxacin and changing to Ancef 1 gm IV q.8h. and monitoring his wound. The patient remained afebrile and his white count trended down and leg wound improved on exam. On the day of discharge, he was evaluated by Dr. Manvelyan and cleared for discharge to home with Augmentin 875/125 mg b.i.d. for a total of 10 days, enteric-coated aspirin 325 mg daily, Lipitor 40 mg daily, diltiazem 30 mg t.i.d., Zetia 10 mg daily, Tricor 145 mg nightly, Diflucan 200 mg daily for one dose for a penile yeast infection, due to antibiotic use, Metformin 500 mg q.p.m., Toprol-XL 25 mg daily and oxycodone 5-10 mg q.4h. p.r.n. pain. He was instructed to monitor his leg wound and call if he had any increased weight, temperature greater than 101 degrees, any drainage from the wound, redness, swelling or change of any kind in his leg wound. He was cleared by Infectious Disease Service and discharged to home in stable condition and will follow up with Dr. Noah Schaffhauser on 5/7/06 at 1 o'clock, Dr. Aaron Phung in three-four days, his primary care physician, and his cardiologist, Dr. Jonathon Sopata in one to two weeks. | has the patient used ancef in the past | {
"answer_end": [
728
],
"answer_start": [
680
],
"text": [
"levofloxacin and changing to Ancef 1 gm IV q.8h."
]
} |
Ms. Christin is an 80-year-old female who presented to an outside hospital with chest pain and shortness of breath. She took one sublingual Nitroglycerin without relief, followed by two more without relief and was then treated with intravenous Lasix, morphine, and Nitroglycerin which resulted in resolution of her pain. Her medical history includes hypertension, hypercholesterolemia, angina, Paget's disease, anemia, and osteoarthritis. An EKG at the hospital showed anterolateral ST depression and her enzymes were negative, ruling out myocardial infarction. Her cardiac symptomatology began in the fall of 1999 and evaluation showed high cholesterol with an LDL 141, EKG with LVH and nonspecific T wave flattening, and a Thallium stress test that was stopped secondary to shortness of breath. Upon admission to Ster Hospital for evaluation of her angina, her laboratory values were consistent with a myocardial infarction and her peak CK was 459 with an MB of 28.7. Her discharge medications include Aspirin 81 mg daily, iron 300 mg three times a day, Hydrochlorothiazide 25 mg daily, Lisinopril 5 mg daily, multivitamin one daily, Relafen 500 mg orally a day, Imdur 60 mg orally a day, Plavix 75 mg daily for 29 days, Lipitor 40 mg daily, Atenolol 25 mg orally a day, and magnesium oxide 420 mg daily. Follow-up with Dr. Porter Luckenbaugh in SH Cardiovascular Group on January at 1:00 p.m. and with Dr. Sammy Kleindienst in the Greenetons Opi Hospital Hematology Clinic. | Was the patient ever prescribed iron | {
"answer_end": [
1055
],
"answer_start": [
1004
],
"text": [
"Aspirin 81 mg daily, iron 300 mg three times a day,"
]
} |
The patient is an 83-year-old female with a history of coronary artery bypass grafting (CABG) in 1993, a left main and diagonal percutaneous transluminal coronary angioplasty (PTCA) with cypher stent, and a bare metal stent in the diagonal for recurrent chest pain. She was admitted for possible myocardial infarction due to anginal pain, however 3 sets of negative cardiac enzymes and no EKG changes ruled this out. She woke up at 5am with substernal epigastric pain, which was unclear if it was angina or esophageal spasm. She took Maalox and 3 nitroglycerin (NTG) with pain that responded to nitro, blood pressure (BP) dropped 140s to 90s but came right back. Admitted medications included ECOTRIN (Aspirin Enteric Coated) 325 mg PO QD, Atenolol 50 mg PO QD, Ferro-Sequels 1 tab PO QD, Lisinopril 30 mg PO QD, Pravachol (Pravastatin) 80 mg PO QHS, Norvasc (Amlodipine) 5 mg PO QD, Imdur ER (Isosorbide Mononitrate (SR)) 120 mg PO QD, Pilocarpine 2% 1 drop OU BID, Bactrim DS (Trimethoprim/Sulfamethoxazole Double Strength) 1 tab PO BID x 12 doses starting today (10/19), Clobetasol Propionate 0.05% Cream TP BID, Allegra (Fexofenadine HCL) 60 mg PO QD, on order for Allegra PO (ref #483093734), Alphagan (Brimonidine Tartrate) 1 drop OU BID, Plavix (Clopidogrel) 75 mg PO QD, Calcium Carbonate 1,500 mg (600 mg elem Ca)/Vit D 200 IU 1 tab PO QD, Zetia (Ezetimibe) 10 mg PO QD, Metformin 250 mg PO BID, Aciphex (Rabeprazole) 20 mg PO QD, and Plavix, BB, ACE, statin, Zetia. Lipid panel was good with total cholesterol 163 and LDL 86 HDL 43. ACE was uptitrated to optimize BP, increased to 30 mg daily with improved BP with SBP in 110s. The patient had a history of anemia and was continued on iron. HCT was stable in low 30s, 32.6 at discharge. The patient was started on Bactrim for 7 days for a urinary tract infection. All other medications were the same. The patient was discharged in stable condition with instructions to monitor BP with uptitration of ACE, take calcium, follow a cardiac and diabetic diet, watch calcium, and take Lovenox and PPI. | How often does the patient take pilocarpine 2% | {
"answer_end": [
966
],
"answer_start": [
937
],
"text": [
"Pilocarpine 2% 1 drop OU BID,"
]
} |
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. | Has patient ever been prescribed colace | {
"answer_end": [
1659
],
"answer_start": [
1602
],
"text": [
"Colace 100 mg p.o. t.i.d., and Coumadin 1 mg p.o. q. h.s."
]
} |
A 42-year-old male was admitted on 4/30 with congestive heart failure exacerbation, hyperhomocysteinemia, chronic renal failure, obesity, hypercholesterolemia, h/o DVT, asthma, OSA, and a worsening of his dyspnea of exertion (DOE) to 3 miles of flat ground with a suspicion of multifocal pneumonia (PNA). He had a D-dimer of 1400, BNP of 2009, and Troponin of 0.84-0.54, which was not considered ischemic, and was not treated. On this admission, his D-dimer was 1207, BNP was 2917, and Troponin was not sent. He had a JVP to earlobe, bibasilar rales, no wheezes, and diffuse pitting edema to his bilateral shins. He had a chest X-ray (CXR) showing increased bilat LL opacities to the periphery with some cephalization of vessels and some opacification. An electrocardiogram (ECG) showed 98 bpm with left anterior fascicular block (LAE) and strain. A chest CT scan from 8/18 (comparing to 4/30) showed per pulm c/w scarring/persistent changes after recent multifocal PNA 4/30, no e/o of new primary lung path, and ground glass c/w pulmonary edema. An echocardiogram showed an ejection fraction (EF) of 25%, moderate right ventricular (RV) dysfunction, and severe tricuspid regurgitation (TR). A follow-up cardiac MRI from 10/16 showed an EF of 23%, global hypokinesis, no wall motion abnormality (WMA), normal RV, and no valve disease. In the ED, he received Duonebs, ASA 325, and Lasix 80mg. His shortness of breath was secondary to CHF exacerbation and fluid overload with no evidence of an infectious pulmonary process contributing to his symptoms. His hypertension was most likely due to taking the wrong dose of Coreg (taking QOD instead of BID). On a BID Coreg regimen, his BP was much better controlled. His renal function remained stable but impaired while he was being evaluated for dialysis as an outpatient but no vascular access was placed yet. He was discharged on 6/7/05 with a full code status and disposition to home with food/drug interaction instruction to take consistently with meals or on empty stomach and activity to walk as tolerated with follow up appointments with Dr. Sackrider at ACH 5/6/05 at 1:30 PM scheduled, Dr. Dauphin at CMC 0/4/05 at 1:40 PM scheduled. He was discharged with ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #55946845) to address a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, PHOSLO (CALCIUM ACETATE) 667 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, DIOVAN (VALSARTAN) 160 MG PO QD prescribed by his cardiologist, CARVEDILOL 6.25 MG PO BID HOLD IF: HR < 60, or SBP < 100, NEPHROCAPS (NEPHRO-VIT RX) 1 TAB PO QD, with an alert overridden: Override added on 4/7/05 by ALAMIN, NORMAN B., M.D. POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: MD Aware, LIPITOR (ATORVASTATIN) 20 MG PO QD with an alert overridden: Override added on 6/7/05 by: POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: home med, and LASIX (FUROSEMIDE) 80 MG PO BID, with a d/c JVP 10cm. He had not been taking his Lasix for 2d prior to d/c. Pt was instructed to diurese further at home on Lasix 80 BID and continue on Coumadin for his h/o recent DVT (4/30) and INR 2-3. | What is the current dose of the patient's lasix ( furosemide ) | {
"answer_end": [
2989
],
"answer_start": [
2957
],
"text": [
"LASIX (FUROSEMIDE) 80 MG PO BID,"
]
} |
Mr. Slunaker is a 56-year-old gentleman who underwent coronary artery bypass grafting x4 and was discharged to home in stable condition on 10/20/06. He presented to see Dr. Emory Bebeau in clinic with a warm and swollen left lower leg with redness and was placed on levofloxacin and vancomycin and had him admitted for left lower leg cellulitis. On admission, he was taking Toprol 25 mg daily, diltiazem 30 mg t.i.d., aspirin 325 mg daily, Lasix 40 mg daily, atorvastatin 40 mg daily, Tricor 145 mg daily, Zetia 10 mg daily, metformin 500 mg daily and potassium chloride slow release 20 mEq daily. Infectious disease was consulted and recommended discontinuing the vancomycin and levofloxacin and changing to Ancef 1 gm IV q.8h. and monitoring his wound. The patient remained afebrile and his white count trended down and leg wound improved on exam. On the day of discharge, he was evaluated by Dr. Manvelyan and cleared for discharge to home with Augmentin 875/125 mg b.i.d. for a total of 10 days, enteric-coated aspirin 325 mg daily, Lipitor 40 mg daily, diltiazem 30 mg t.i.d., Zetia 10 mg daily, Tricor 145 mg nightly, Diflucan 200 mg daily for one dose for a penile yeast infection, due to antibiotic use, Metformin 500 mg q.p.m., Toprol-XL 25 mg daily and oxycodone 5-10 mg q.4h. p.r.n. pain. He was instructed to monitor his leg wound and call if he had any increased weight, temperature greater than 101 degrees, any drainage from the wound, redness, swelling or change of any kind in his leg wound. He was cleared by Infectious Disease Service and discharged to home in stable condition and will follow up with Dr. Noah Schaffhauser on 5/7/06 at 1 o'clock, Dr. Aaron Phung in three-four days, his primary care physician, and his cardiologist, Dr. Jonathon Sopata in one to two weeks. | What was the dosage prescribed of oxycodone | {
"answer_end": [
1299
],
"answer_start": [
1263
],
"text": [
"oxycodone 5-10 mg q.4h. p.r.n. pain."
]
} |
This 54 year old gentleman presented to the Wickpro Conch Medical Center with an infected left lower leg pressure ulcer with open and gangrenous muscle exposed through the posterior wound. His past medical history is significant for insulin dependent diabetes mellitus, peripheral vascular disease, coronary artery disease, congestive heart failure, history of atrial fibrillation/flutter, and right sacroiliac joint decubitus ulcer. His physical examination revealed mottled distal extremities, bilateral inspiratory wheezes, and a positive bowel sound. The patient underwent a four vessel coronary artery bypass graft on 6/17/95 and left lower extremity fasciotomy on 11/27/95 and was taken to the Operating Room on 7/25/95 for a preoperative diagnosis of a left lower extremity infected pressure sore. Intraoperatively, the patient was noted to have necrosis of both heads of the gastrocnemius muscle and copious amounts of antibiotic-containing solution was used to irrigate the wound, for which he was started on Ampicillin, Gentamicin, and Flagyl empirically until culture results returned and was taken back on 2/29/95 for a second irrigation and debridement procedure. The patient was placed on Klonopin 1 mg po tid, Tylenol 650 mg p.o. q4h p.r.n. headache, Aspirin 81 mg p.o. qd, Albuterol nebulizer 0.5 cc in 2.5 cc of normal saline q.i.d., Capoten 25 mg p.o. qh, Chloral hydrate 500 mg p.o. q.h.s. p.r.n. insomnia, Clonopin 1 mg p.o. t.i.d., Digoxin 0.375 mg p.o. qd, Colace 100 mg p.o. b.i.d., Insulin NPH 38 units subcu b.i.d., Milk of Magnesia 30 cc p.o. qd p.r.n. constipation, Multivitamins one capsule p.o. qd, Mycostatin 5 cc p.o. q.i.d., Percocet one or two tabs p.o. q3-4h p.r.n. pain, Metamucil one packet p.o. qd, Azmacort six puffs inhaled b.i.d., Axid 150 mg p.o. b.i.d., Ofloxacin 200 mg p.o. b.i.d. x 7 days, and Insulin NPH 38 units in the morning and 38 units at night. The patient was initially ruled out for a myocardial infarction following his first operative procedure and had no episodes of hypotension. He was switched over from Gentamicin to Ofloxacin to continue his antibiotic course and has been followed by the Infectious Disease service, receiving 7 more days of po Ofloxacin as an outpatient. The patient's medications upon discharge include Aspirin 81 mg po qd, Digoxin 0.325 mg po qd, Azmacort 6 puffs inhaled bid, Heparin 5000 units subcu bid, Zantac 150 mg po bid, Lasix 40 mg po qd, Capoten 25 mg q 8, Albuterol nebulizers 0.5 cc in 2.5 cc normal saline qid, NPH insulin 38 units subcu bid, Nystatin swish and swallow 5 cc po qid, Bactrim DS one tab po bid, Tylenol 650 mg po q4h prn headache, Chloral hydrate 500 mg po qhs prn insomnia, Clonopin 1 mg po tid, Colace 100 mg po bid, Milk of Magnesia 30 cc po qd prn constipation, Multivitamins one capsule po qd, Mycostatin 5 cc po qid, Percocet one or two tabs po q3-4h prn pain, Metamucil one packet po qd, Azmacort six puffs inhaled bid, Axid 150 mg po bid, and Ofloxacin 200 mg po bid x 7 days. | Is there history of use of axid | {
"answer_end": [
1834
],
"answer_start": [
1736
],
"text": [
"Azmacort six puffs inhaled b.i.d., Axid 150 mg p.o. b.i.d., Ofloxacin 200 mg p.o. b.i.d. x 7 days,"
]
} |
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 patient ever been on aranesp | {
"answer_end": [
3403
],
"answer_start": [
3369
],
"text": [
"Prandin 0.5 mg p.o. with each meal"
]
} |
The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg | has there been a prior depakote | {
"answer_end": [
1282
],
"answer_start": [
1202
],
"text": [
"PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily,"
]
} |
Mr. Quigg is a 42-year-old man with history of diabetes, end-stage renal disease on hemodialysis, left Charcot foot complicated by recurrent cellulitis who presented with left lower leg swelling, erythema, and pain. On admission, his temperature was 100.8, heart rate was 111, and blood pressure was 140/70. His left lower extremity had 1+ pitting edema with erythema on the anterior shin and foot. He was uptitrated to 5mg and also lopressor, started on Lyrica and oxycodone for breakthrough pain, and received Fentanyl PCA. His home medications included Colace 100 mg b.i.d., folate 1 mg p.o. daily, gemfibrozil 600 mg b.i.d., Lantus 30 mg subcu q.p.m., Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d., and Coumadin. His Lipitor was decreased to 20mg due to rhabdomylosis risk, and he was also started on low dose b-blocker to reduce perioperative MI risk prior to his surgery. His Vancomycin was continued given his history of MRSA cellulitis, with a goal of a level less than 20, and he was bridged with heparin with a goal PTT of 60-80. He was restarted on his Lantus and Aspart doses with meals, and his Coumadin was held prior to surgery and decreased to 20mg with a repeat lipid panel in 4-6 weeks. He required antibiotics which were discontinued at this time and he was discharged with dry sterile dressing changes to his residual limb daily, PTT goal 60-80, INR goal 2-3 until stable off of levofloxacin, monitoring of FS and adjustment of DM regimen, monitoring pain scale and decreasing pain medications as pain improves, hemodialysis M/W/F, and follow up with Dr. Carpino voice message left on his medical assistant's voice mail and Dr. Lynes 6/10/06 at 9:30am. Psychiatry service was consulted who recommended low dose Ativan prior to him going for dialysis. He was initially placed on a ketamine drip and given IV Levofloxacin and IV Flagyl to cover gram negatives and anaerobes respectively, and started on oxycontin 80mg tid with oxycodone for breakthrough pain and Lyrica for neuropathic pain. He was comfortable prior to discharge on this current regimen. | Has this patient ever tried nephrocaps | {
"answer_end": [
737
],
"answer_start": [
656
],
"text": [
"Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d.,"
]
} |
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. | What is the dosage of coumadin | {
"answer_end": [
1176
],
"answer_start": [
1116
],
"text": [
"Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d.,"
]
} |
The patient is a 46-year-old gentleman with End stage renal disease thought to be secondary to hepatitis C virus positive, on chronic hemodialysis who was admitted status post fall and seizure. On the day of admission, he complained of feeling dizzy and slumped onto the floor, and was given 500 ccs of normal saline and was no longer orthostatic, comfortably sitting up in the bed. Past medical history reveals mild mental retardation since about 10 years ago, movement disorder (tics) on Stelazine, end stage renal disease thought to be secondary to hypertension, status post parathyroidectomy for secondary hyperparathyroidism, partial thyroidectomy for goiter incidentally found at surgery, status post partial gastrectomy for peptic ulcer disease in the 1960's, history of MRSA from wound in 1988, hepatitis B surface antibody positive and hepatitis C virus positive. Medications on admission included Calcium carbonate, 1250 mg PO tid; nephrocaps, 1 PO qd; DHT, 0.2 mg PO qd; and Stelazine, 2 mg PO tid. There are no known allergies and the patient was a former smoker with a history of alcohol abuse but no IV drug use. Vital signs showed lying blood pressure of 96/60, pulse 80, sitting up blood pressure 104/70, pulse 96, temperature 97.5, O2 sat 95% on room air, JVD of 4 cms, no lymphadenopathy, chest clear to auscultation, heart revealed S1, S2, normal rate and rhythm with a 1/6 systolic murmur best heard at the left upper sternal border, no CVA tenderness, abdomen soft, non-tender, no masses, bowel sounds positive, guaiac negative with brown stool, tender, edematous dorsal aspect of right foot, with full range of motion at the ankle joint, left extremity benign, neuro exam was grossly nonfocal. Laboratory data revealed sodium 142, potassium 4.8, chloride 94, bicarb 32, BUN 38, creatinine 8.6, glucose 168, white count of 8.82, hematocrit 35, platelets 246, calcium 9.7. Chest x-ray revealed mild pulmonary vascular redistribution with no significant CHF and no infiltrates, ankle x-rays on the right revealed no fracture or dislocation, EKG revealed normal sinus rhythm at a rate of 76, axis 2 degrees, some 1 mm ST elevations in I and AVL, T-waves flat in lead III. The patient was observed overnight, put on an oral renal diet, checking orthostatics frequently, and underwent dialysis again with no orthostasis. Right foot films revealed non-displaced fractures of the second, third, fourth and fifth metatarsal bones, and Orthopaedic service was consulted who put the patient in a bivalve cast with a toe plate. Physical therapy was consulted and the patient was allowed to sit in a chair and engage in non-weight bearing activities and his foot was elevated on three pillows for 72 hours, and discharged on his medications from admission to a rehab/skilled nursing facility per wishes of patient, family and per recommendation of physical therapy. | Why was the patient on normal saline | {
"answer_end": [
1220
],
"answer_start": [
1146
],
"text": [
"lying blood pressure of 96/60, pulse 80, sitting up blood pressure 104/70,"
]
} |
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 had 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 is a 68 year old female with a history of long standing hypertension and diabetes who experienced an increase in shortness of breath, dyspnea on exertion and paroxysmal nocturnal dyspnea while in Tempefayscot, Michigan 76498. She was admitted to the Short Stay Unit for evaluation with a systolic blood pressure greater than 200, and was administered Procardia XL 20 mg p.o. x 1, Aspirin, Nitropaste, and IV Lasix, to which she had a significant response. Her past medical history includes a stress echocardiogram which showed mitral regurgitation, hypokinesis of the septum and AV block on exertion with an ejection fraction of about 40%. On admission, she was taking Cardura, Vasotec, and Metoprolol. Her electrocardiogram showed bradycardia at 40 with a left bundle branch pattern and she had 2:1 AV block. Her chest x-ray showed an enlarged heart with pleural effusions and cephalization, and her laboratory data SMA-7 was within normal limits. She underwent pacemaker placement without any difficulty and it was interrogated the day after placement without any problem. She was discharged in stable condition with no reportable disease and no adverse drug reactions on Keflex 250 mg p.o. q.i.d. for 5 days; Norvasc 5 mg p.o. qd; Hydrochlorothiazide 25 mg p.o. qd and Vasotec 20 mg p.o. b.i.d. She will follow-up with her Cardiologist in one week and will probably have her blood pressure medications further adjusted at that point. | What treatments has patient been on for a systolic blood pressure in the past | {
"answer_end": [
386
],
"answer_start": [
238
],
"text": [
"She was admitted to the Short Stay Unit for evaluation with a systolic blood pressure greater than 200, and was administered Procardia XL 20 mg p.o."
]
} |
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. | Was the patient ever prescribed amiodarone hcl | {
"answer_end": [
1195
],
"answer_start": [
1169
],
"text": [
"AMIODARONE HCL & WARFARIN,"
]
} |
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. | What is has been given for treatment of her her blood sugars | {
"answer_end": [
1439
],
"answer_start": [
1382
],
"text": [
"The patient's Insulin dosages were adjusted in the manner"
]
} |
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 is the dosage of niacin | {
"answer_end": [
796
],
"answer_start": [
770
],
"text": [
"Glucophage 500 once a day,"
]
} |
This 63 year-old male with a history of peripheral vascular disease, hypertension, non-insulin dependent diabetes mellitus, coronary artery disease, aortic stenosis, and status post bilateral lower extremity bypass grafts presented to the hospital with increasing left lower extremity pain. At which time tPA infusion was commenced and an occlusion of the left lower extremity vein graft was found in the area of the mid-thigh with no passage of contrast and minimal reconstitution of collaterals to his foot. He was managed medically for a few days and underwent catheterization which revealed a right dominant system, a discreet 40% lesion in the proximal left main, a discreet 30% lesion in the proximal left anterior descending artery, 100% lesion in the first marginal branch of the left circumflex artery, as well as 100% lesion in the second marginal branch of the left circumflex artery. He was taken to the operating room on 0/27/02 for an aortic valve replacement with a #23 Carpentier-Edwards pericardial valve and mitral valvuloplasty with an Alfieri suture repair, as well as coronary artery bypass graft times three with left internal mammary artery to the left anterior descending artery, left radial to obtuse marginal one, and left radial to posterior descending artery. During his hospital course he was on MEDICATIONS: Glipizide 5 mg b.i.d., Hydrochlorothiazide 50 mg q.d., Lisinopril 20 mg q.d., Simvastatin 20 mg q.d., Amlodipine 5 mg q.d., Imdur 30 mg q.d., and Toprol 100 mg q.d. and enteric coated aspirin, and he remained on his aspirin and Lopressor, as well as Coumadin. He was placed on the Portland protocol and remained on a full ten-day course of Flagyl and Cefotaxime for his preoperative pneumonia. On his pre-discharge examination he was discharged to rehabilitation with DISCHARGE MEDICATIONS: Coumadin 4 mg p.o. q.hs to maintain INR between 2 and 3, aspirin, Diltiazem 30 mg t.i.d., Simvastatin 20 mg q.d., Colace 100 mg t.i.d., Nexium 20 mg q.d., Niferex-150 b.i.d., Glipizide 5 mg b.i.d., Lasix 40 mg b.i.d., and Lopressor 50 mg b.i.d. with CZI sliding scale. | Has this patient ever been prescribed czi | {
"answer_end": [
2097
],
"answer_start": [
2051
],
"text": [
"Lopressor 50 mg b.i.d. with CZI sliding scale."
]
} |
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 previous hyzaar 50/12.5 | {
"answer_end": [
819
],
"answer_start": [
746
],
"text": [
"Hyzaar 50/12.5 q. day, lisinopril 60 mg q. day, Neurontin 1200 mg t.i.d.,"
]
} |
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure. | Has this patient ever been on rezulin | {
"answer_end": [
903
],
"answer_start": [
885
],
"text": [
"K-Dur 60 mEq q.d.,"
]
} |
The 65-year-old female patient with a history of hypertension, hypercholesterolemia, non-insulin-dependent diabetes mellitus, and no known hx of CAD was admitted with chest pain. On November 1997, an exercise treadmill test revealed a maximal heart rate of 127 and maximal blood pressure of 134/80, with 1 millimeter of ST depression in V5 and T-wave inversions in V4-V6, consistent with, but not diagnostic ischemia. She had a history of sarcoidosis, seizure disorder, pacemaker placement, appendectomy, total abdominal hysterectomy for cervical cancer, adult onset diabetes mellitus, and left calf deep vein thrombosis in 1993. Medications at the time of admission included Linsinopril 5 mg q.d., Pravachol 20 mg q.h.s., aspirin 325 mg q. day, atenolol 0.5 mg b.i.d., Dilantin 200 mg b.i.d., Ventolin inhaler p.r.n., and ferrous gluconate 325 mg t.i.d. Hematocrit on June 1997 was noted to be 29.3 and the patient had been on iron supplements since then. On admission, she was given Nitrol paste and, for her ischemia, she was transfused with one unit of packed red cells. Diagnostic ischemia was present, and she was started on aspirin and atenolol. In the past, she has been treated with prednisone and black secondary to iron supplementation. Two cardiac catheterizations were performed, which showed a 70% residual osteal diagonal stenosis and 0% left anterior descending stenosis. A stent was placed in the diagonal artery with 0% residual stenosis and her left anterior descending was stented. At the time of discharge her medications included Ticlid 250 mg p.o. b.i.d., albuterol inhaler 2 puffs q.i.d. as needed for shortness of breath, enteric-coated aspirin 325 mg p.o. q.d., atenolol 37.5 mg p.o. b.i.d., nitroglycerin 1/150 sublingual one tablet q. 5 minutes times three for chest pain, and Dilantin 200 mg p.o. b.i.d. She was also taking linsinopril 5 mg q.d., Pravachol 20 mg q.h.s., ferrous gluconate 325 mg t.i.d., and Ventolin inhaler p.r.n. She is scheduled to followup with Dr. Doug Millis in her office in one week and will follow up with cardiology as an outpatient. | Was the patient ever given albuterol inhaler for shortness of breath; | {
"answer_end": [
1646
],
"answer_start": [
1579
],
"text": [
"albuterol inhaler 2 puffs q.i.d. as needed for shortness of breath,"
]
} |
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. | Was the patient ever prescribed heparin | {
"answer_end": [
1014
],
"answer_start": [
958
],
"text": [
"He was anticoagulated on heparin and loaded on Coumadin,"
]
} |
This 79-year-old male was admitted for coronary artery disease and aortic stenosis with a history of hypertension, dyslipidemia, chest radiation, prostate cancer, osteoporosis, and urinary incontinence. A CABG x3 with a LIMA to the LAD, a saphenous vein graft to the PDA, and a saphenous vein graft to the obtuse marginal was done on 10/3/06, while the aortic valve was only found to be mildly stenotic. Postoperatively, he was transferred to the Intensive Care Unit in a stable fashion, and was found to have an inferior lateral ischemia on EKG, which was resolved after cardiac catheterization. He was weaned off pressors and extubated, and started on Lopressor and gentle diuresis. On postoperative day #3, his Norvasc was started and he was transferred to the Step-Down Unit. On postoperative day #4, he was slightly tachycardic with ambulation and his beta-blockers were titrated up, with PA and chest x-ray looking good. He was started on empiric levofloxacin for questionable pneumonia and found suitable for discharge on postoperative day #5, however, he had isolated temperature and his white count was found to be trending and he was hypertensive. A positive blood culture was found from when he had been in the Intensive Care Unit and he was continued on levofloxacin, while he was also started on vancomycin due to left leg cellulitis at the knee. On postoperative day #10, a fluid collection was found above the knee to the mid calf, and he underwent a drainage and irrigation of his left lower extremity saphenous vein donor site. After this procedure, he was transferred back to the Step-Down Unit and was discharged on postoperative day #5. | Was the patient on any medication for her questionable pneumonia. | {
"answer_end": [
992
],
"answer_start": [
927
],
"text": [
"He was started on empiric levofloxacin for questionable pneumonia"
]
} |
A 42-year-old male was admitted on 4/30 with congestive heart failure exacerbation, hyperhomocysteinemia, chronic renal failure, obesity, hypercholesterolemia, h/o DVT, asthma, OSA, and a worsening of his dyspnea of exertion (DOE) to 3 miles of flat ground with a suspicion of multifocal pneumonia (PNA). He had a D-dimer of 1400, BNP of 2009, and Troponin of 0.84-0.54, which was not considered ischemic, and was not treated. On this admission, his D-dimer was 1207, BNP was 2917, and Troponin was not sent. He had a JVP to earlobe, bibasilar rales, no wheezes, and diffuse pitting edema to his bilateral shins. He had a chest X-ray (CXR) showing increased bilat LL opacities to the periphery with some cephalization of vessels and some opacification. An electrocardiogram (ECG) showed 98 bpm with left anterior fascicular block (LAE) and strain. A chest CT scan from 8/18 (comparing to 4/30) showed per pulm c/w scarring/persistent changes after recent multifocal PNA 4/30, no e/o of new primary lung path, and ground glass c/w pulmonary edema. An echocardiogram showed an ejection fraction (EF) of 25%, moderate right ventricular (RV) dysfunction, and severe tricuspid regurgitation (TR). A follow-up cardiac MRI from 10/16 showed an EF of 23%, global hypokinesis, no wall motion abnormality (WMA), normal RV, and no valve disease. In the ED, he received Duonebs, ASA 325, and Lasix 80mg. His shortness of breath was secondary to CHF exacerbation and fluid overload with no evidence of an infectious pulmonary process contributing to his symptoms. His hypertension was most likely due to taking the wrong dose of Coreg (taking QOD instead of BID). On a BID Coreg regimen, his BP was much better controlled. His renal function remained stable but impaired while he was being evaluated for dialysis as an outpatient but no vascular access was placed yet. He was discharged on 6/7/05 with a full code status and disposition to home with food/drug interaction instruction to take consistently with meals or on empty stomach and activity to walk as tolerated with follow up appointments with Dr. Sackrider at ACH 5/6/05 at 1:30 PM scheduled, Dr. Dauphin at CMC 0/4/05 at 1:40 PM scheduled. He was discharged with ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #55946845) to address a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, PHOSLO (CALCIUM ACETATE) 667 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, DIOVAN (VALSARTAN) 160 MG PO QD prescribed by his cardiologist, CARVEDILOL 6.25 MG PO BID HOLD IF: HR < 60, or SBP < 100, NEPHROCAPS (NEPHRO-VIT RX) 1 TAB PO QD, with an alert overridden: Override added on 4/7/05 by ALAMIN, NORMAN B., M.D. POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: MD Aware, LIPITOR (ATORVASTATIN) 20 MG PO QD with an alert overridden: Override added on 6/7/05 by: POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: home med, and LASIX (FUROSEMIDE) 80 MG PO BID, with a d/c JVP 10cm. He had not been taking his Lasix for 2d prior to d/c. Pt was instructed to diurese further at home on Lasix 80 BID and continue on Coumadin for his h/o recent DVT (4/30) and INR 2-3. | Is the patient currently or have they ever taken coreg | {
"answer_end": [
1674
],
"answer_start": [
1608
],
"text": [
"dose of Coreg (taking QOD instead of BID). On a BID Coreg regimen,"
]
} |
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. | How often does the patient take pravachol | {
"answer_end": [
1732
],
"answer_start": [
1674
],
"text": [
"Cartia XT that is diltiazem extended release 300 mg daily,"
]
} |
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). | Has a patient had lantus | {
"answer_end": [
1067
],
"answer_start": [
985
],
"text": [
"Protonix 40 daily, metformin 1500 daily, Lantus 60 daily, Humalog 20 before meals,"
]
} |
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 the patient taken medication for potential staph infection. | {
"answer_end": [
1097
],
"answer_start": [
1042
],
"text": [
" She was given 2 doses of vancomycin to cover potential"
]
} |
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. | Is there history of use of simvastatin | {
"answer_end": [
1407
],
"answer_start": [
1338
],
"text": [
"simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily,"
]
} |
This is a 61-year-old gentleman with severe pulmonary hypertension secondary to chronic PEs, OSA, gout, bilateral hip replacements who presents with two falls in the past two days. He was compliant with his medication regimen and denies dietary indiscretion. He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5, initially being supertherapeutic with a daily goal of negative 500 to 1 L with IV Lasix once or twice a day as needed, his home dose being 160 mg p.o. His baseline room air oxygen saturation was 90-93% and he should use oxygen as treatment for his pulmonary hypertension and be provided with oxygen at home. He was treated for his hip pain initially with oxycodone which was changed to Dilaudid for better pain control, and he should be changed back to his home dose of oxycodone when discharged. He also has a history of gout which was exacerbated with diuresis and he is on his home doses of allopurinol and colchicine, Indocin being added and he should receive a total of three days of Indocin. Tylenol and narcotics as previously described can be used to help with his gouty pain. His GI regimen includes Nexium at home and Prilosec while an inpatient, and he should be switched back to Nexium when discharged from rehabilitation. His lab results on discharge include a creatinine of 1, hematocrit of 53.1 and INR of 2.3, potassium being 3.9 and magnesium being 2.0. The discharge medications include Coumadin 11 mg on Monday, Wednesday and Friday and 12 mg the other days of the week, Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day, hydrochlorothiazide 25 once a day, Lasix 160 IV once per day, allopurinol 200 once per day, colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain, Tylenol 500-1000 mg p.o. q.6 h. p.r.n. pain not to exceed 4 gm total from all sources in a 24-hour period, Ambien 10 mg p.o. nightly p.r.n. insomnia. He is being discharged to rehab with a followup with his cardiologist, Dr. Insco, and an appointment with Endocrinology. | Why was the patient prescribed narcotics | {
"answer_end": [
1126
],
"answer_start": [
1065
],
"text": [
"previously described can be used to help with his gouty pain."
]
} |
The patient is an elderly woman with known coronary artery disease status post coronary artery bypass graft who had her Beta blocker, Pendalol decreased from 5 mg to 2.5 mg prior to this trip to Glension Street. On return to the hospital she developed substernal chest pain that radiated down both arms, which was treated with Amoxicillin given to her by her son who is a physician. At this visit, he did start her on Prinivil and she took a sublingual nitroglycerin that completely relieved her symptoms. Laboratory studies were significant for a white blood cell count of 5.46, hematocrit 40.1, platelets 190, Cardiac Troponin I was 0.0, CK was 102, and Urinalysis was negative. Chest x-ray was clear with no infiltrates, and EKG was normal sinus rhythm with normal intervals and normal axis with a left bundle branch block pattern and first degree atrioventricular block with no change compared to an EKG done on January, 1997. MEDICATIONS ON ADMISSION: 1) Zocor 5 mg p.o. q.h.s., 2) Prinivil 5 mg p.o. q. day., 3) Pendalol 2.5 mg p.o. q. day., 4) Aspirin 325 mg p.o. q. day., 5) Synthroid 0.100 mg p.o. q. Monday, Wednesday and Friday and 0.12 mg p.o. Tuesday, Thursday, Saturday and Sunday., 6) Pepcid p.r.n. From here, she was managed medically with increases in her ACE inhibitor, Statin and the addition of nitrates. After the cardiac catheterization, she developed a large right groin hematoma at the puncture site and a bruit was noted. An ultrasound was done that revealed a pseudoaneurysm of the common femoral artery, which was later surgically repaired. MEDICATIONS ON DISCHARGE: 1) Aspirin 325 mg p.o. q. day., 2) Colace 100 mg p.o. b.i.d., 3) Synthroid 100 mcg p.o. q. Monday, Wednesday and Friday, 112 mcg p.o. q. Tuesday, Thursday, Saturday and Sunday., 4) Lisinopril 10 mg p.o. q. day., 5) Beclomethasone diproprionate double strength spray to each nostril b.i.d., 6) Zocor 20 mg p.o. q.h.s., 7) Toprol XL 75 mg p.o. q. day., 8) Imdur 30 mg p.o. q. day., 9) Augmentin one tablet p.o. q. day for seven additional days. The patient had been having low grade fevers and a cough productive of a green sputum, and experienced diaphoretic episodes, both at rest and exertion, which was relieved by a sublingual nitroglycerin. The latest echocardiogram in May of 1997 showed an ejection fraction of 35% with mid to distal septal and apical akinesis and inferior akinesis with mild mitral regurgitation, and she went 4 minutes and 18 seconds on an exercise tolerance test with Thallium which showed only fixed defects, no reversible defects. | Is the patient currently or have they ever taken beta blocker | {
"answer_end": [
172
],
"answer_start": [
108
],
"text": [
"who had her Beta blocker, Pendalol decreased from 5 mg to 2.5 mg"
]
} |
Ms. Watterson, a 75 year old female with a history of CHF/CAD, A-fib, lung CA s/p R wedge resection, basal cell CA on lip s/p resection, and uterine CA s/p TAH, was admitted to the hospital with increasing SOB, weight gain, orthopnea, fever, chills, decreased UOP x1-2 days, L leg swelling, and a T98.6, P72, BP121/65, RR18. In the ED she was given O2 and 40mg of Lasix IV, and her daily meds included Acetylsalicylic Acid 325mg PO daily, Allopurinol 100mg PO daily, Docusate Sodium 100mg PO BID, Esomeprazole 20mg PO daily, Ferrous Sulfate 325mg PO TID, Glipizide 5mg PO BID, KCL Slow Release 20MEQ PO BID, Levothyroxine Sodium 100mcg PO daily, Lorazepam 0.5mg PO daily PRN Insomnia/Anxiety, Metolazone 2.5mg PO daily, Metoprolol Succinate Extended Release 100mg PO daily, Multivitamins 1tab PO daily, Pravastatin 40mg PO bedtime, Torsemide 20mg PO BID, and Warfarin Sodium 2mg PO QPM. CXR, diuresis with IV medications, EKG, R/O MI, and Abdo CT were performed and the patient improved clinically. Antibiotics such as Azithromycin and Levofloxacin were initiated for PNA, and Cefpodoxime 200mg PO QD x 7 days was added for gram pos coverage. In addition, she was given Tessalon Perels 100mg PO TID PRN cough, Guiatuss 10ml PO Q4H PRN cough, Loperamide 2mg PO Q6H PRN diarrhea, and Metolazone 2.5mg PO daily PRN weight gain. The patient was supertheraputic on Coumadin and it was held throughout her admission, INR remained 3.9 to 4.0 in the setting of hemoptysis, started on 1/2 her home coumadin with VNA/PCP f/u in 2 days, d/ced on Coumadin 1mg qpm, UA and urine CTX were negative, developed diarrhea concerning for c.diff but had only been on azithromycin x1 day, all stool studies were negative, presumed viral gastroenteritis, started on loperamide before discharge to be continued prn diarrhea, pt's po DM rx were held during her admission covered with Lantus and Insulin Asp SS, HgA1c was sent and was in nl range, home po rx were restarted on discharge, kept on her home dose of levoxyl, TSH was rechecked and within nl range, home po rx Allopurinol was also continued, the following antibiotics were added: Levofloxacin 500mg by mouth every 48 hours for 7 days, Cefpodoxime 200mg by mouth once daily for 7 days, Tessalon Perels 100mg by mouth three times daily as needed for cough, Guiatuss 10ml by mouth every 4 hours as needed for cough, Loperamide 2mg by mouth every 6 hours as needed for diarrhea, Coumadin: Were taking 2mg by mouth in the pm, now take 1mg by mouth in the pm, and instructions, pt took Metolazone 2.5mg and Torsamide 40mg x1 which did. During her stay the patient remained in afib with good rate control on her bblocker, rx of betablocker, ASA, statin, was diuresed with IV Lasix in the ED, Metolazone 2.5mg and Torsamide 40mg x1, on 2/22 pt's weight increased to 72.9 kg from 70.6kg, restarted on her home rx of torsemide 20mg po bid, was roughly negative 1.3L, pt's daily weights decreased off diuretics, was found to be supertheraputic on her coumadin which was held throughout admission, PNA was initially treated with azithromycin but as her cough and o2 levels persisted, pt was begun on ceftaz and levo for gram pos coverage (levo) double gram neg coverage, and ceftaz changed to cefpodoxime 200mg po qd x 7 days, however pt had only been on azithromycin x 1 day, all stool studies were negative, presumed viral gastroenteritis | Has patient ever been prescribed glipizide | {
"answer_end": [
576
],
"answer_start": [
555
],
"text": [
"Glipizide 5mg PO BID,"
]
} |
Patient, a 37 year old male with multiple admissions for atypical chest pain, morbid obesity, restrictive lung disease by PFTs, sleep apnea, and borderline hypertension, came in complaining of SOB and "asthma attack" and anxiety. He responded well to Nebs and Ativan in the ED and was discharged with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QD with Food/Drug Interaction Instruction to take consistently with meals or on empty stomach, Klonopin (Clonazepam) 1 MG PO TID, Colace (Docusate Sodium) 100 MG PO BID, Prozac (Fluoxetine HCL) 20 MG PO QD, Zestril (Lisinopril) 10 MG PO QD, Niferex-150 150 MG PO BID, Percocet 1 TAB PO Q6H X 7 Days Starting Today (6/1) PRN pain, Azithromycin 250 MG PO QD X 4 Days Starting IN AM (6/1) with Food/Drug Interaction Instruction to take with food, Prednisone Taper PO (60 mg QD X 2 day(s) (0/22/01-09), then 50 mg QD X 2 day(s) (2/26/01-09), then 40 mg QD X 2 day(s) (9/28/01-09), then 30 mg QD X 2 day(s) (4/0/01-09), then 20 mg QD X 2 day(s) (8/26/01-09), then 10 mg QD X 2 day(s) (2/20/01-10), then 5 mg QD X 2 day(s) (3/6/01-10)), on order for Azithromycin PO (ref # 63922816) with Potentially Serious Interaction: Clonazepam & Azithromycin, Prilosec (Omeprazole) 20 MG PO QD, Albuterol Inhaler 2 Puff Inh QID, Atrovent Inhaler (Ipratropium Inhaler) 2 Puff Inh QID, and was instructed to return to work after an appointment with a local physician. He was discharged with a diagnosis of sob of unknown etiology, and other diagnoses included borderline HTN, anxiety disorder, PPD, and morbid obesity. | Has the patient had previous ecasa ( aspirin enteric coated ) | {
"answer_end": [
345
],
"answer_start": [
301
],
"text": [
"ECASA (Aspirin Enteric Coated) 325 MG PO QD,"
]
} |
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. | Has this patient ever been prescribed isordil ( isosorbide dinitrate ) | {
"answer_end": [
877
],
"answer_start": [
833
],
"text": [
"Isordil (Isosorbide Dinitrate) 30 mg PO TID,"
]
} |
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. | Is the patient currently or have they ever taken mgoxide | {
"answer_end": [
1006
],
"answer_start": [
948
],
"text": [
"Mgoxide 500mg daily, Ambien prn, Amox prior to procedures."
]
} |
This 64-year-old male with a history of coronary artery disease, CHF, EF of 15%, status post AVR, and NSTEMI initially presented to outside hospital with chief complaint of shortness of breath and was found to have a BNP of 747 as well as a troponin I of 0.43. He was diuresed, started on Carvedilol and improved, and placed on a heparin drip. His medications on admission included Aspirin 81, Lisinopril 20, Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d., Nystatin 500 b.i.d., Paxil 20 daily, Glipizide 10 daily, Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily, heparin drip and Spironolactone. During his hospital stay, he was continued on Aspirin, Plavix, beta-blocker and ACE inhibitor, which were titrated to effect, started on a statin and continued on Niaspan, and maintained on a nicotine patch. He was also prescribed Spironolactone 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, and Coumadin 5 mg p.o. at night. The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics, which were discontinued on admission and was encouraged to stop smoking. He had runs of ectopy and SVT, so was placed on a heparin drip. Left heart cath revealed wall defect consistent with a right coronary artery infarct and the patient was continued on Spironolactone. He was discharged in a stable condition on Aspirin 325 p.o. daily, Lisinopril 4 mg p.o. daily, Nicotine patch 14 mg per day topical, Spironolactone 25 mg p.o. daily, Paxil 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, Carvedilol 12.5 mg p.o. twice daily, Plavix 75 mg daily, Gemfibrozil 900 mg p.o. twice daily and Coumadin 5 mg p.o. at night, with instructions to follow up with PCP and Cardiology as well as EP, to check his daily weights and report any increases to his PCP, and to arrange to have his INR drawn on 6/21/06 and follow-up INRs to be drawn every seven days. | Has this patient ever been treated with nicotine patch | {
"answer_end": [
848
],
"answer_start": [
817
],
"text": [
"maintained on a nicotine patch."
]
} |
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 this patient ever been prescribed potassium chloride | {
"answer_end": [
2218
],
"answer_start": [
2121
],
"text": [
"Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy,"
]
} |
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. | What is the current dose of lisinopril | {
"answer_end": [
946
],
"answer_start": [
919
],
"text": [
"Diltiazem 240 mg p.o. q.d.,"
]
} |
Patient DOUGLASS W. DILEO was admitted to CAR with unstable angina and discharged on 11/23/04 with a code status of full code and disposition of home w/ services. The patient has a possible allergy to NSAIDs with reaction unknown and a probable allergy to SIMVASTATIN, NSAIDs, SHELLFISH, and Codeine. The patient was given atropine and Fem stop placed over cath due to femoral hematoma. CT ruled out retroperitoneal bleed and her HCT dropped from 32 to 26, and she was transfused 2 U PRBC. The anti-ischemic regimen at discharge included ENTERIC COATED ASA (ASPIRIN ENTERIC COATED) PO 325 MG QD (ref #57541802), INSULIN NPH HUMAN 36 UNITS QAM; 40 UNITS QPM SC, NEURONTIN (GABAPENTIN) 600 MG PO BID, PLAVIX (CLOPIDOGREL) 75 MG PO QD, ZETIA (EZETIMIBE) 10 MG PO QD, LISINOPRIL 40 MG PO QD, HYDROCHLOROTHIAZIDE 25 MG PO QD, PREVACID (LANSOPRAZOLE) 30 MG PO QD, GLUCOPHAGE (METFORMIN) 1,000 MG PO BID, and ATENOLOL 25 MG PO QD, with no statin due to muscle pain history. The patient was instructed to take 1/2 their regular home dose of Atenolol until they see their cardiologist/PCP, and to follow a diet of house/low chol/low sat. fat and house/ADA 2100 cals/dy. Patient was to follow up with Dr. Brechbiel in 2 weeks and Dr. Damms for right leg ultrasound in 2-4 weeks. The patient also had a below-the knee right tibial vein DVT, was not anticoagulated for this below-the knee clot because of low risk of embolization and her recent HCT drop/hematoma. The patient was also given IBUPROFEN 600-800 MG PO Q6H PRN Pain for left knee pain after a fall one week prior. The patient was instructed to continue home diabetic regimen and followup with PCP/cardiology and schedule a repeat right leg ultrasound test (“LENI”) to follow the small blood clot in her leg in the future. | has there been a prior zetia ( ezetimibe ) | {
"answer_end": [
763
],
"answer_start": [
733
],
"text": [
"ZETIA (EZETIMIBE) 10 MG PO QD,"
]
} |
Ms. Halnon is a 67-year-old female with multiple medical comorbidities and a past medical history significant for cardiac transplant in 1993, and hip replacement in July 2005, complicated by wound infection, and need for prolonged rehabilitation who presented from Port Medical Center to Ephma Mersources Ni Memorial Hospital with three days of progressive worsening shortness of breath. Upon admission, her mental status was borderline, but it improved with discontinuation of standing analgesic and decreasing of her clonazepam. A head CT showed no acute processes. She had a right upper arm cellulitis and urinary tract infection on screening urinalysis. She was anemic and was found to be vancomycin resistant Enterococcus positive, but repeated cultures demonstrated MRSA negative. For her heart failure, she was diuresed with IV and transitioned to oral torsemide and they entered discharge dose of torsemide 200 mg p.o. twice per day. She was given a five-day course of levofloxacin (used to address recurrent UTI) and then a two-day course of Ancef, her cellulitis was initially treated with levofloxacin and transitioned to Bactrim based on antibiogram sensitivities. A long-term Foley was placed for comfort with catheter in place. While on Bactrim for her UTI, her creatinine rose from 1.5 to 1.6, but cleared with this regimen. For her chronic anemia, the patient was continued on iron (which was increased to three times per day) and darbepoetin, folate was added. She was asymptomatic from her chronic anemia. She was given two units of packed red blood cells in March, 2005, and two more units on February, 2006. Her admission weight was 133 kg and her creatinine was 1.6. At discharge, she was hemodynamically stable, afebrile, and breathing comfortably on three liters of oxygen. Her discharge medications included Vitamin C 500 mg twice per day, Imuran 25 mg daily, PhosLo 667 mg three times per day, clonazepam 0.25 mg twice daily, iron sulfate 325 mg three times per day, folate 1 mg daily, Dilaudid 2 mg every six hours as needed for pain, lactulose 30 mL four times per day as needed for constipation, prednisone 5 mg every morning, Sarna topical every day apply to affected areas, multivitamin daily, Coumadin 2.5 mg daily, goal INR 2 to 3, zinc sulfate 220 mg daily, Ambien 5 mg before bed as needed for insomnia, torsemide 200 mg by mouth two times per day, cyclosporine 50 mg twice daily, Colace 100 mg twice daily, insulin NPH 14 units every evening, insulin NPH 46 units every morning, esomeprazole 20 mg once per day, DuoNeb 3/0.5 mg inhaled every six hours as needed for shortness of breath, Aranesp 50 mcg subcutaneously once per week, NovoLog sliding scale before meals, Lexapro 20 mg once per day, Maalox one to two tablets every six hours as needed for upset stomach, and Lipitor 20 mg once per day. Outstanding issues include following INR the goal of 2 to 3, following weight and clinical signs of volume overload, following up on loose stools for possible Clostridium difficile infection, and following clinical signs for evidence of urinary tract infection treating with antibiotics as necessary. | has there been a prior multivitamin | {
"answer_end": [
2246
],
"answer_start": [
2155
],
"text": [
"Sarna topical every day apply to affected areas, multivitamin daily, Coumadin 2.5 mg daily,"
]
} |
The patient is a 70 year old white female with a history of long standing hypertension, hypercholesterolemia, and history of tobacco use who presented upon transfer from Ra Memorial Hospital with chief complaint of post MI unstable angina. She had a history of long standing hypertension and had chest pain in the past including at least one previous episode of rule out MI. She was admitted on 22 of April to Hen Mo Gardensworth Sent Hospital with signs and symptoms consistent with acute MI and apparently received salvage therapy with IV Streptokinase and TPA. On 0 of August, the patient presented to Cooker View Home Hospital with an episode of heavy substernal chest pressure relieved with SL and topical nitrates, and her EKG showed no worrisome ischemic changes. She was transferred to CNMC on IV Heparin, IV Nitroglycerin at 140 micrograms per minute, IV Heparin drip, Lopressor, aspirin one a day, beta blockade and aspirin. She had several episodes of typical substernal chest pain with minimal exertion that were relieved with SL Nitroglycerin, and additional episodes of chest pain that were low in intensity but prolonged, each of these requiring several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was treated by the addition of a calcium channel blocker, and her admission labs showed hematocrit 34.2, WBC 6.7, platelets 159,000, PTT 50.0 on IV Heparin. Postcatheterization, the patient showed mild hypertension which was treated by the addition of a calcium channel blocker, and she was also diuresed for fluid overload. Prior to discharge, she had two additional episodes of chest pain that were low in intensity but prolonged. Each of these required several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was unlikely to be cardiac in origin and more likely represented either GI symptomatology or an anxiety reaction. The patient underwent an exercise treadmill test on the modified Bruce protocol which showed no evidence for ischemia. On discharge, she was prescribed Nifedipine XL 90 mg po q am, Lopressor 50 mg po b.i.d., Zantac 150 mg po q hs, aspirin 81 mg po q d, Serax 15 mg po q 6 h or q hs prn, and Nitroglycerin 1/150 grain q 5 minutes x 3 SL prn chest pain. She was discharged to home and is to follow up with her primary care physician, Dr. Gayle Demeritt, and her cardiologist, Dr. Mark Willians, at ACSH. ALLERGIES: Penicillin which causes anaphylaxis. The patient is a 70 year old white female who had a history of long standing hypertension, hypercholesterolemia, and history of tobacco use and presented upon transfer from Ra Memorial Hospital with chief complaint of post MI unstable angina. She was admitted on 22 of April to Hen Mo Gardensworth Sent Hospital and apparently received salvage therapy with IV Streptokinase and TPA. On 0 of August, she presented to Cooker View Home Hospital with an episode of heavy substernal chest pressure relieved with SL and topical nitrates, and her EKG showed no worrisome ischemic changes. Upon transfer to CNMC, she was without chest pain and was given IV Nitroglycerin at 140 micrograms per minute, IV Heparin drip, Lopressor, aspirin one a day, beta blockade and aspirin. She had several episodes of typical substernal chest pain with minimal exertion that were relieved with SL Nitroglycerin, and additional episodes of chest pain that were low in intensity but prolonged, each of these requiring several Nitroglycerins and antacids to be relieved. Her admission labs showed hematocrit 34.2, WBC 6.7, platelets 159,000, PTT 50.0 on IV Heparin. Postcatheterization, the patient showed mild hypertension which was treated by the addition of a calcium channel blocker, and she was also diuresed for fluid overload. Prior to discharge, she had two additional episodes of chest pain that were low in intensity but prolonged. Each of these required several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was unlikely to be cardiac in origin and more likely represented either GI symptomatology or an anxiety reaction. The patient underwent an exercise treadmill test on the modified Bruce protocol which showed no evidence for ischemia. On discharge, she was prescribed Nifedipine XL 90 mg po q am, Lopressor 50 mg po b.i.d., Zantac 150 mg po q hs, aspirin 81 mg po q d, Serax 15 mg po q 6 h or q hs prn, and Nitroglycer | Has the patient had previous nitrates | {
"answer_end": [
720
],
"answer_start": [
691
],
"text": [
"with SL and topical nitrates,"
]
} |
The patient is a 42-year-old white man who presented with complaints of fever to 103 and chills, a productive cough, and groin pain lasting three days. At age three, he was diagnosed with Wilms' tumor on the left, which was resected and subsequently treated with wide field radiation, after which he developed radiation-induced tyroid cancer, at which time he underwent subtotal thyroidectomy. In May of 1997, he underwent living related donor renal transplantation for chronic renal failure, however, the postoperative course was complicated by cytomegalovirus infection, presenting with diarrhea and requiring hospitalization in February 1997. He was treated with ganciclovir and subsequently maintained on Cytovene. He had one fever spike on hospital day one and Levaquin was initiated on hospital day three along with intravenous antibiotics, after which he was switched to oral antibiotics, including Levaquin and Augmentin. His blood pressures were stabilized at 130/80 with the initiation of a second antihypertensive medication, Nifedipine XL, for which he was maintained for two days at 30 mg. Hematologic studies revealed that he was continued on anticoagulation for atrial fibrillation at 4 mg daily with an INR remaining in his goal parameters. His creatinine level was 2.5 and his cyclosporine level was 303 on admission, reaching a maximum of 19.8 on hospital day four. Endocrine studies revealed a TSH of 0.02, a T4 of 6.0, and a THPR of 1.47. The patient's pulmonary status improved on oxygen and on intravenous antibiotics, and all studies for atypical organisms were negative. Prior to discharge, the patient's pulmonary status had returned to baseline and had entirely resolved. The patient was discharged on Augmentin 250/125 mg t.i.d., Levaquin 250 mg q.d., CellCept 500 mg b.i.d., Neoral 100 mg b.i.d., Prednisone 10 mg q.d., Synthroid 125 mcg q.d., INP insulin 14 units subcu q.a.m., regular insulin subcu p.r.n., Axid 150 mg q.d., nadolol 80 mg q.d., nifedipine XL 30 mg q.d., Coumadin 4 mg q.d., and iron sulfate 300 mg q.d., and follow-up was scheduled for bone densitometry in July 1998, with Dr. Clinton Ardizone in January 1998, and with Dr. Win in March. | Is there history of use of nifedipine xl | {
"answer_end": [
1102
],
"answer_start": [
1037
],
"text": [
"Nifedipine XL, for which he was maintained for two days at 30 mg."
]
} |
Mr. Mauras is a 72-year-old man with history of stable angina, type 2 diabetes, peripheral vascular disease, former smoking history, and history of seizure disorder with cataracts. He had occasional anginal symptoms prior to discharge and took about two nitroglycerins per week. Over the past week, he had escalating chest pain requiring one nitroglycerin per day. The pain was relieved by rest and nitroglycerin. One week prior to admission, his digoxin was stopped and his amiodarone was decreased. His Plavix was stopped and his Coumadin was held. On the morning of admission, he had chest pain and received Lopressor, Enalapril, Lovenox treatment dose and a Plavix load in the ED. He was found to have flash pulmonary edema and in atrial fibrillation with rapid ventricular response and was taken back to the catheterization lab and given four stents to his saphenous vein graft, OM1 with good resolution of his symptoms. He was transferred to the floor and was given an amiodarone load given his ejection fraction and increased ectopy on telemetry. His troponin had been trended down to the 0.2s by discharge and his beta-blocker and ACE inhibitor were titrated to heart rate and blood pressure. Prior to anticipated discharge, he re-developed flash pulmonary edema secondary to atrial fibrillation with rapid ventricular response and was re-loaded with digoxin. He was started on Mucomyst precath with good effect, had a difficult-to-place Foley, and was started on Flomax with good effect. His creatinine on discharge was 1.2, his metformin was held, and he was continued on Lantus with sliding scale insulin. He was given three units of packed red blood cells given his history of CAD and was prescribed with Amiodarone 200 mg, Enteric-coated aspirin 325 mg, Librium 10 mg, Colace 200 mg, Ferrous gluconate 324 mg, Lasix 40 mg, Nitroglycerin one tab, Dilantin 100 mg, Senna two tabs, Coumadin 3 mg, Lipitor 80 mg, Flomax 0.4 mg, Plavix 75 mg, Lantus 14 units, Metformin 500 mg, Ranitidine 150 mg, Digoxin 0.125 mg, Enalapril 10 mg, and Atenolol 50 mg, with follow-up appointments with his PCP, Dr. Kelley Hernon of Electrophysiology on 7/8/05, and Dr. Daft on 9/20/05, and INR checked on 8/4/05 or 7/8/05 with Coumadin adjusted accordingly. | Has the patient had enteric-coated aspirin in the past | {
"answer_end": [
1766
],
"answer_start": [
1736
],
"text": [
"Enteric-coated aspirin 325 mg,"
]
} |
76 year-old male with significant cardiac history, including NSTEMI and asystole arrest, presented with weakness, dizziness, and chest pain for 3 days, currently chest pain-free. EKG on admission showed subtle changes with <1 mm ST depression in lateral leads. Patient was given Acetylsalicylic Acid 325 mg PO QD, Ativan 0.5 mg x 1, Magnesium Chloride 500 mg x 1, Atenolol 25 mg PO QD, Atorvastatin 80 mg PO QD, Docusate Sodium 100 mg PO BID, Losartan 50 mg PO QD, Amlodipine 10 mg PO QD, Pantoprazole 40 mg PO QD, Lipitor (Atorvastatin) 80 mg PO daily, Colace (Docusate Sodium) 100 mg PO BID, Potassium Chloride IV, Potassium Chloride Immediate Release PO, Magnesium Gluconate (Magnesium Gluconate) 400 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, ASA 325 mg x 1, and MIBI ordered. Metformin was held and DM protocol was instituted while in house. Patient was at risk for cardiac event and was treated with BB and titrated as tolerated, with Tele monitoring. Nutrition consult was ordered due to recent decrease in appetite and FTT picture. SW was consulted and patient was discussed at length for services at home when discharged. Patient left AMA despite lengthy discussion about his health and risk for MI/death. Number of Doses Required (approximate): 3 for MG GLUCONATE (MAGNESIUM GLUCONATE) and 2 for TERAZOSIN HCL 1 MG PO DAILY. Home meds included ASA 325 mg daily, lipitor 80 mg daily, amlodipine 5 mg daily, protonix 40 mg daily, losartan 50 mg daily, and terazosin 1 mg daily. An override was added on 7/10/07 by KETCHAM, JAKE WALDO, M.D., PH.D. on order for KCL IV (ref # 687673059) with POTENTIALLY SERIOUS INTERACTION: LOSARTAN POTASSIUM & POTASSIUM CHLORIDE Reason for override: md aware, and on 11/8/07 by DERNIER, AUGUSTINE A., P.A.-C. on order for KCL IMMEDIATE RELEASE PO (ref # 856712835) with the same POTENTIALLY SERIOUS INTERACTION. Patient was instructed to resume regular exercise and to avoid grapefruit unless instructed otherwise. He was also given a diet of House/2gm Na/Carbohydrate Controlled/Low saturated fat low cholesterol. | Has the patient ever had terazosin | {
"answer_end": [
1495
],
"answer_start": [
1403
],
"text": [
"amlodipine 5 mg daily, protonix 40 mg daily, losartan 50 mg daily, and terazosin 1 mg daily."
]
} |
Eli Frigge (047-45-81-2) was admitted with lightheadedness and hypertension, and discharged with a principal discharge diagnosis of s/p pacemaker placement and other diagnoses including CAD s/p CABG x 2, RAS c L renal stent, bilateral common iliac artery stents, PAF, and DM. A dual chamber Guidant pacemaker was inserted without difficulty on 10/13, programmed to DDI 60 mode, and BB was initiated with a plan to continue Toprol XL upon discharge. Cardiology recommended dc'ing Aspirin and adding Coumadin with Plavix for anticoagulation, but deferred decision to pt's outpatient cardiologist. The patient was instructed to take ACETYLSALICYLIC ACID 325 MG PO DAILY, LIPITOR (ATORVASTATIN) 80 MG PO DAILY, CLINDAMYCIN HCL 300 MG PO QID X 12 doses starting after IV ANTIBIOTICS END, PLAVIX (CLOPIDOGREL) 75 MG PO DAILY, COLACE (DOCUSATE SODIUM) 100 MG PO BID, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, GLIPIZIDE 2.5 MG PO DAILY, LISINOPRIL 5 MG PO BID HOLD IF: SBP <120, REGLAN (METOCLOPRAMIDE HCL) 10 MG PO TID, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO DAILY with Food/Drug Interaction Instruction, and SENNA TABLETS (SENNOSIDES) 2 TAB PO BID consistently with meals or on an empty stomach. Dulcolax and stool softeners were administered for constipation with good response, and the patient was instructed to continue Clindamycin until running out of pills, call doctor or go to nearest ER if having fever > 100.4, chills, nausea, vomiting, chest pain, shortness of breath, or anything concerning, and to continue stool softeners for constipation and resume all home meds upon discharge. The patient was discharged to home with services in stable condition. | Has the patient had multiple senna tablets ( sennosides ) prescriptions | {
"answer_end": [
1205
],
"answer_start": [
1118
],
"text": [
"SENNA TABLETS (SENNOSIDES) 2 TAB PO BID consistently with meals or on an empty stomach."
]
} |
Shaull Darin was admitted on 8/12/2007 and discharged on 7/17/2007 with a full code status and disposition to home. During his stay, he was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, with an Override Notice added on 10/30/07 by LAUB , STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) due to a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, ATENOLOL 37.5 MG PO DAILY, CAPTOPRIL 12.5 MG PO BID, on order for KCL IMMEDIATE RELEASE PO ( ref # 545368405 ) due to a POTENTIALLY SERIOUS INTERACTION: CAPTOPRIL & POTASSIUM CHLORIDE, CELEXA ( CITALOPRAM ) 40 MG PO DAILY, PLAVIX ( CLOPIDOGREL ) 75 MG PO DAILY, DIGOXIN 0.125 MG PO DAILY, EPLERENONE 25 MG PO DAILY, FOLATE ( FOLIC ACID ) 1 MG PO DAILY, LASIX ( FUROSEMIDE ) 60 MG PO BID, Alert overridden: Override added on 10/30/07 by GOODWINE , BUFORD H B. , M.D. on order for LASIX PO ( ref # 145213873 ), NEURONTIN ( GABAPENTIN ) 100 MG PO TID, LORAZEPAM 0.5 MG PO DAILY PRN Anxiety, LOVASTATIN 40 MG PO DAILY, with an Override Notice added on 10/30/07 by PERAULT , SHELBY H M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) due to a POTENTIALLY SERIOUS INTERACTION: LOVASTATIN & WARFARIN, POTENTIALLY SERIOUS INTERACTION: NIACIN , VIT. B-3 & LOVASTATIN, OMEPRAZOLE 20 MG PO DAILY, TEMAZEPAM 15-30 MG PO BEDTIME PRN Insomnia, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, COSOPT ( TIMOLOL/DORZOLAMIDE ) 1 DROP OU BID, Alert overridden: Override added on 11/14/07 by LUTHY , LANNY D E. , M.D. on order for COSOPT OU ( ref # 517414331 ), COUMADIN ( WARFARIN SODIUM ) 1 MG PO QPM, TRAVATAN 1 DROP OU BEDTIME Instructions: OU. thanks., amiodarone toxicity, Peripheral neuropathy, restless legs, Spinal, ASA/Plavix, BB. Some concern for ischemia causing his, to 60 bid. Cont Dig/nitrate/BB, ACEi. Checked echo, no change., Rhythym: Tele. Lyte replete78M with significant CAD, iCM EF 15-20%, presenting with SOB, underwent Adenosine MIBI with no focal defects, LHC with no new disease and no interventions, RHC with wedge of 16, PFTs 1992 with no COPD, CR 1.4-1.8, Barrett's on PPI, neuropathy, neurontin, celexa, glaucoma on eye drops, CV, NAS, 2L fluid restrict diet, held coumadin for cath then restarted it with 2mg on 8/1, 1mg on 6/10, INR of 1.7 on d/c, additional comments included measuring daily weights and calling MD if weight increases by more than 5 lbs in one week or 2-3 lbs in one day, continuing coumadin and checking INR on Monday, taking lasix 60 twice a day, and resuming all home medications. Patient discharged in stable condition with instructions to follow up volume status and check INR on 2/21/07. Number of Doses Required ( approximate ): 7. Override Notice: Override added on 10/30/07 by LAUB, STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) and Alert overridden: Override added on 11/14/07 by LUTHY , LANNY D E. , M.D. on order for | has there been a prior ppi | {
"answer_end": [
2076
],
"answer_start": [
2059
],
"text": [
"Barrett's on PPI,"
]
} |
The patient is a 62-year-old white male with a long-standing hypotension of 30 to 40 mmHg who is treated with hypoglycemics and has a significant history of diabetes of 20 years without neurological or retinopathy. He also has a positive family history of cardiac risk factors and denies cigarettes. He had a percutaneous transluminal coronary angioplasty at the Ribush Bassta Syark Hospital in 1985 and has had rule outs for myocardial infarction since, with the last one approximately in 1990 at Dormro General Hospital. At 1:00 a.m., the patient had recurrent chest pain and took four to five Nitroglycerins without relief and was front-loaded with TPA, Heparin, Aspirin, Morphine sulfate, and Nifedipine. The patient was placed on an intra-aortic balloon pump in preparation for coronary artery bypass surgery and was discharged on prophylactic anticoagulation with Coumadin, taking Diltiazem 60 t.i.d., Glyburide, and Lisinopril 20 PO q.day. The patient had a coronary artery bypass graft x three with a saphenous vein graft to the LAD, first branch of the obtuse marginal and the posterior descending artery. On postoperative day #3, the patient had atrial fibrillation which was treated and controlled pharmacologically, and he was requested to follow-up with Dr. Schoening in 6 weeks and his cardiologist in 2 weeks. | Is the patient currently or have they ever taken aspirin | {
"answer_end": [
692
],
"answer_start": [
630
],
"text": [
"was front-loaded with TPA, Heparin, Aspirin, Morphine sulfate,"
]
} |
Mr. Serafine is a 78-year-old gentleman with class III heart failure and aortic stenosis. He was admitted to the Intensive Care Unit on 3 mcg of epinephrine and insulin and Precedex. He was prescribed Atenolol 12.5 mg daily, aspirin 325 mg daily, metformin 500 mg b.i.d., and Humalog insulin 12 units q.i.d., intravenous Lasix but had weaned Lasix drip and had intermittent boluses of 40 mg IV to promote diuresis with good result. He was also found to have a positive urinary tract infection and was started on ciprofloxacin for a total of five days. The patient at one point required 5 liters of nasal cannula to get his saturations in the 90s. He was prescribed three days, Motrin 400 mg q.8h. p.r.n. pain, NovoLog 24 units subq q.a.c., Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily, patient was also discharged on NovoLog sliding scale subcutaneous q.a.c. with doses of Lasix 40 mg b.i.d., baby aspirin 81 mg daily, and potassium chloride slow release 20 mEq b.i.d. for three days. He was then discharged to home in stable condition with visiting nurse and medications including Atenolol 12.5 mg daily, aspirin 325 mg daily, metformin 500 mg b.i.d., and Humalog insulin 12 units q.i.d., Ciprofloxacin 500 mg q.6h. for remaining four doses, baby aspirin 81 mg daily, Lasix 40 mg b.i.d., for three days along with potassium chloride slow release 20 mEq b.i.d. for three days, Motrin 400 mg q.8h. p.r.n. pain, NovoLog 24 units subq q.a.c., Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily, and NovoLog sliding scale subcutaneous q.a.c. His beta-blocker was increased with good result and he underwent a minimally invasive aortic valve replacement with a 25-mm Carpentier-Edwards pericardial valve. He was then to follow up with Dr. Collin Hyman in six weeks and his cardiologist Dr. Louie W Eilders in one week. | Has the patient had lantus in the past | {
"answer_end": [
803
],
"answer_start": [
740
],
"text": [
"Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily,"
]
} |
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 treated with nexium ( esomeprazole ) | {
"answer_end": [
2359
],
"answer_start": [
2322
],
"text": [
"NEXIUM (ESOMEPRAZOLE) 20 MG PO DAILY,"
]
} |
Mr. Wolfinbarger is a 55 year old male with Coronary Artery Disease who was admitted to Enreen Dallout Medical Center for cardiac catheterization. His Past Medical History includes non-Hodgkin's lymphoma, status bone marrow transplant and chemotherapy in 1992 and 1993; history of hypercholesterolemia, hypertension, insulin dependent diabetes, gastroesophageal reflux disorder and chronic renal insufficiency. He is allergic to Benadryl. His medications on admission included Toprol XL 200 mg q.d. Procardia XL 90 mg q.d, Lipitor 20 mg q.d., aspirin 325 mg q.d., Zantac 150 mg b.i.d., NPH humulin insulin 32 units each morning and 18 units each evening subcutaneously, Valium 5 mg q.d., Minipress 1 mg b.i.d. His physical examination was within normal limits, no varicosities. He underwent harvesting of the left radial artery for graft and a coronary artery bypass grafting x three with a left internal mammary artery to the left anterior descending coronary artery, saphenous vein graft from the posterior descending coronary artery to the aorta and a radial artery from the saphenous vein graft to the obtuse marginal coronary artery. Postoperatively, he had an episode of rapid atrial flutter and was chemically converted to sinus rhythm with Corvert and has remained in sinus rhythm on Lopressor and diltiazem for 24 hours. His saphenous vein harvest site showed some slight erythema to be treated with antibiotics by mouth. He is discharged on Axid 150 mg b.i.d, Lipitor 20 mg q.d., NPH Humulin insulin 32 Units every morning, 18 Units every evening; Diltiazem 60 mg t.i.d., Lopressor 150 mg b.i.d., enteric coated aspirin 125 mg once a day, Valium 5 mg once a day, Keflex 500 mg four times a day for 7 days, Percocet 1 to 2 tablets every four hours as needed for pain. | Has the patient ever had zantac | {
"answer_end": [
585
],
"answer_start": [
499
],
"text": [
"Procardia XL 90 mg q.d, Lipitor 20 mg q.d., aspirin 325 mg q.d., Zantac 150 mg b.i.d.,"
]
} |
Mrs. Wetterauer is a 54-year-old female with coronary artery disease status post inferior myocardial infarction in March of 1997, with sick sinus syndrome, status post permanent pacemaker placement, and paroxysmal atrial fibrillation controlled with amiodarone; also with history of diabetes mellitus and hypertension. On 1/11, she experienced severe respiratory distress and was unable to be intubated on the field. She was ultimately intubated at Sirose, and an echocardiogram showed an ejection fraction of 25 to 30 percent with flat CKs. She was diuresed six liters and a right heart catheterization showed a pulmonary artery pressure of 40/15, wedge of 12, and cardiac output of 5.2. Hemodynamics indicated her cardiac output was dependent on her SVR. At the outside hospital, a right upper lobe infiltrate was noted and she was given gentamicin 250 mg times one, and clindamycin 600 mg. She was diagnosed with pneumonia and treated with clindamycin, which caused resolution of her white count. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. Her last admission was on 10/6 for atypical chest pain, and she was placed on Bactrim Double Strength b.i.d. times a total of seven days, as well as Lovenox 60 mg b.i.d., aspirin 325 p.o. q.d., lisinopril 40 mg p.o. b.i.d., digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. Home medications include amiodarone 200 mg p.o. q.d., Glyburide 5 mg p.o. q.d., Lopressor 50 mg p.o. b.i.d., Prempro 0.625/2.5 p.o. q.d., lisinopril 40 mg p.o. q.d., Coumadin, nitroglycerin sublingual, Zantac, beclomethasone, and Ventolin. Medications on transfer, Lovenox 60 mg b.i.d., aspirin 325 p.o. q.8, digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. The patient was also placed on Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Glyburide 5 mg p.o. q.d., Lasix 20 mg p.o. q.d., atenolol 150 mg p.o. q.d., diltiazem CD 240 mg p.o. q.d., and resolved with 20 mg of Lasix p.o. q.d. Mrs. Wetterauer was admitted to the Aley Coness-o Meoak Medical Center for paroxysmal atrial fibrillation controlled with amiodarone, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma. For her anxiety, the patient was treated acutely with Ativan and her problem resolved quite well, and she became more comfortable in the hospital. Diabetes Mellitus was managed with Glyburide held initially on admission, covered with insulin sliding scale, and restarted on discharge. Edema was managed with Lasix 20 mg p.o. q.d. and resolved with 20 mg of Lasix p.o. q.d. Urinary Tract Infection was managed with antibiotics. She was discharged with medications including amiodarone 200 mg p.o. q.d., lisinopril 40 mg p.o. b.i.d., Tapazole 10 mg | Was the patient ever given medication for severe anxiety | {
"answer_end": [
2722
],
"answer_start": [
2679
],
"text": [
"the patient was treated acutely with Ativan"
]
} |
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 an infection in the past | {
"answer_end": [
1377
],
"answer_start": [
1350
],
"text": [
"with antibiotics initially,"
]
} |
Mr. Faiella is a 78 year old man who presented with two episodes of chest pain and had recently undergone a MV and TV repair with SVG to OM1. An EKG showed pacing and a CK revealed a TnI elevated at 0.17, while Adenosine MIBI revealed a fixed inf/lat defect, consistent with LCX disease. He was sent home with Nitroglycerin, and the pain recurred while watching TV, resolving with one Nitroglycerin tablet. CV: Ischemia was ruled out for MI, added Isordil to regimen, ASA, and continue Carvedilol, Captopril. Likely to have CAD, Adenosine MIBI origin, will stop nitrates. Pt was able to amubulate w/o SOB or CP, CHF: euvolemic, continue Lasix, Aldactone, Digoxin. Neuro: recent history of TIA, on Coumadin, may not want to reverse. On order, he was prescribed ECASA (Aspirin Enteric Coated) 325 mg PO QD, Coumadin PO (ref # 44750239), Captopril 12.5 mg PO TID, Aldactone PO (ref # 94240639), Digoxin 0.125 mg PO QOD, Lasix (Furosemide) 80 mg PO BID, Niferex-150 150 mg PO BID, Nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain HOLD IF: SBP < 100, Aldactone (Spironolactone) 25 mg PO QD, Coumadin (Warfarin Sodium) 6 mg PO QD, Carvedilol 3.125 mg PO BID HOLD IF: SBP < 100, and Celexa (Citalopram) 20 mg PO QD, with potential serious interactions between Aspirin & Warfarin, Captopril & Spironolactone, and Potassium Chloride & Digoxin. He was instructed to call his cardiologist and return to the emergency department if his chest pain recurs, worsens, or he becomes short of breath, and to make an appointment with Dr. Moxness within the next 1-2 weeks. VNA was asked to oversee medications, check vitals, and draw PT/INR once a week, while PT was asked to help Mr. Muskett regain strength, flexibility, and range of motion. Number of Doses Required (approximate): 5. There were overrides on orders for COUMADIN PO (ref # 44750239) and ALDACTONE PO (ref # 94240639) due to Potentially Serious Interactions: ASPIRIN & WARFARIN, CAPTOPRIL & SPIRONOLACTONE, and POTASSIUM CHLORIDE & SPIRONOLACTONE. | Has this patient ever been treated with celexa ( citalopram ) | {
"answer_end": [
1222
],
"answer_start": [
1190
],
"text": [
"Celexa (Citalopram) 20 mg PO QD,"
]
} |
The patient was a 46 year old woman with a history of asthma who was admitted with an asthma exacerbation. She had asthma since childhood and was never intubated nor previously treated with steroids. On admission, her physical examination showed wheezes bilaterally in the lungs. Her laboratory examination showed hematocrit of 41.6, white count of 9.66, and platelets of 199,000. She was treated with steroids, Solu-Medrol and then prednisone 60 milligrams orally, beta agonist, nebulizer and ampicillin, and continued her oral theophylline as she had been using as an outpatient. Her medications on admission were Theo-Dur 200 milligrams by mouth 3 times a day, prednisone 60 milligrams by mouth each day, Albuterol nebulizer, ampicillin 500 milligrams by mouth 3 times a day and Bronkosol. Allergies included sulfa drugs. She slowly improved with decreased wheezing in her breath sounds and increased peak flow from 300. She was discharged on May 3rd with all her usual medications, plus Keflex 500 milligrams by mouth 4 times a day and prednisone 50 milligrams by mouth each day, and was to follow up with her doctor. | Has the patient had theo-dur in the past | {
"answer_end": [
663
],
"answer_start": [
598
],
"text": [
"on admission were Theo-Dur 200 milligrams by mouth 3 times a day,"
]
} |
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 a patient had enteric-coated aspirin | {
"answer_end": [
2371
],
"answer_start": [
2305
],
"text": [
"Enteric-coated aspirin 325 mg q.d., Lasix 600 mg q.6h p.r.n. pain,"
]
} |
Loyd O. Karpinsky underwent a laparoscopic adjustable gastric band placement without complication and was transferred to the PACU in stable condition. Her pain was well controlled with PCA analgesia on POD0 and transitioned to po elixir analgesia following a negative upper GI study exhibiting no leaks. She was discharged on LANTUS (INSULIN GLARGINE) 10 UNITS SC QD, RANITIDINE HCL SYRUP 150 MG PO BID, ROXICET ELIXIR (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain, COLACE (DOCUSATE SODIUM) 100 MG PO TID HOLD IF: diarrhea, PHENERGAN (PROMETHAZINE HCL) 25 MG PR Q6H PRN Nausea, and AUGMENTIN SUSP. 250MG/62.5 MG (5ML) (AMOXICIL...) 10 MILLILITERS PO TID Instructions: for five days. At the time of discharge, her pain was well controlled and she was tolerating a stage 2 diet, afebrile, and all incisions were clean dry and intact. She was instructed to take the medications without regard to meals and to resume regular exercise, walking as tolerated. She was also to follow up with Dr. Hinsley in 1-2 weeks and Diabetes Management Service in 3 weeks, and to avoid strenuous activity, swimming, bathing, hot tubbing, and driving or drinking alcohol while taking prescription narcotic (pain) medications. | has the patient had narcotic ( pain ) medications. | {
"answer_end": [
1215
],
"answer_start": [
1167
],
"text": [
"taking prescription narcotic (pain) medications."
]
} |
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 patient ever been prescribed isordil | {
"answer_end": [
1247
],
"answer_start": [
1213
],
"text": [
"The patient was started on Isordil"
]
} |
Patient Isaac Vanover, Jr., a 44-year-old man with a history of CAD s/p MI x2 4/14 with PCI, in stent thrombosis, and re-stenting, was admitted multiple times for CP with associated fatigue and SOB. He was placed on ECASA (Aspirin Enteric Coated) 325 MG PO QD, COLACE (Docusate Sodium) 100 MG PO BID PRN constipation, ENALAPRIL MALEATE 5 MG PO QAM HOLD IF: SBP<100, POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & ENALAPRIL MALEATE (on order for KCL IMMEDIATE RELEASE PO (ref #56599393)), ATIVAN (Lorazepam) 1 MG PO TID Starting Today March PRN anxiety HOLD IF: RR<12 or pt is lethargic, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain HOLD IF: SBP < 100, ZOLOFT (Sertraline) 100 MG PO QD, ZOCOR (Simvastatin) 20 MG PO QHS, PLAVIX (Clopidogrel) 75 MG PO QD, VIOXX (Rofecoxib) 25 MG PO QD, ZANTAC (Ranitidine HCl) 150 MG PO BID PRN dyspepsia, and ATENOLOL 25 MG PO QD with Food/Drug Interaction Instruction. Managed on Hep, TNG gtt, Plavix, ACE, B blocker, and Demerol, the pain recurred and he was transferred to BVH for cath. Cardiac catheterization on 8/18/02 showed non-obstructive CAD with LMCA, LAD, LCx, and RCA all OK. Pulmonary level of suspicion for PE is low, so D-dimer is sent and PE ruled out. Mild fluid overload was managed with Lasix to keep I/O's 500-1000cc neg. Pain could represent pericarditis, but psychiatric etiology for CP becomes more likely and psychiatric follow-up and treatment for anxiety and depression is recommended. WBC count increased 4/10 but no other sign/symptom of infection, CXR showed no infiltrates, and the patient was discharged stable with instructions to schedule an appointment with the primary doctor within 2-4 weeks, and if chest pain changes in character or is associated with new symptoms, the patient is to notify their doctor or call 911. | has the patient had nitroglycerin 1/150 ( 0.4 mg ) | {
"answer_end": [
676
],
"answer_start": [
594
],
"text": [
"NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain HOLD IF: SBP < 100,"
]
} |
Marcelo Walts was admitted to the medical service for a CHF exacerbation and was given ECASA (Aspirin Enteric Coated) 325 mg PO QD, Captopril 12.5 mg PO TID with a potential serious interaction with Potassium Chloride, Lasix (Furosemide) 40 mg PO TID, Levoxyl (Levothyroxine Sodium) 100 mcg PO QD, Nitroglycerin 1/150 (0.4 mg) 1 tab SL Q5 min x 3 PRN Chest Pain HOLD IF: SBP<[ ], Zocor (Simvastatin) 20 mg PO QHS with a potential serious interaction with Niacin, Vit. B-3, Plavix (Clopidogrel) 75 mg PO QD, Atenolol 25 mg PO QD, Nitropatch (Nitroglycerin Patch) 0.2 mg/hr TP QHS, Glyburide 5 mg PO BID, Isordil (Isosorbide Dinitrate) 10 mg PO BID, and a diet of House/Low Chol/Low Sat. Fat and 4 gram Sodium. Activity was limited to Walking as tolerated, and the patient was also given instructions to give ECASA on an empty stomach, and to avoid grapefruit with Zocor unless instructed otherwise. Upon discharge, the patient was given a Full Code status and was sent Home with a follow up appointment with Sandler on 11/28/02. The patient also underwent cardiac catheterization and stent placement of RCA with the medications Heparin, ASA, Plavix, Metoprolol, nitrates, ACE-I, statin, lasix, and nebs for wheezing, and was monitored for lytes. Upon discharge, the patient was stable and advised to follow up with Dr. Lidstone and Dr. Darlin for post-cath management and overall management of CHF and flash pulmonary edema. | Is there a mention of of levoxyl ( levothyroxine sodium ) usage/prescription in the record | {
"answer_end": [
297
],
"answer_start": [
252
],
"text": [
"Levoxyl (Levothyroxine Sodium) 100 mcg PO QD,"
]
} |
A 74-year-old female with pulmonary sarcoid, CHF, and CRI presented with SOB after stopping Lasix several weeks ago. On admission, she was in mildly decompensated CHF and was started on more aggressive diuresis with Lasix 40 IV BID increased to 80 BID on HD2, with Cardiology Service consulting, then increased to Lasix drip at 15/hr on HD3 with I/O goal 1-2 l neg. She did well on this and by HD5 was near her dry weight of 49kg and her drip was transitioned back to PO Lasix. She was continued on Hydralazine, Lopressol and Isordil on HD3, titrated up to 20 TID. She has history of MI with stents and was continued on ASA, Plavix, Zocor, Coumadin (ref#960263524) PO, MVI Therapeutic 1 TAB PO QD, Iron Sulfate 325 MG PO TID, Folate 1 MG PO QD, Calcium Carbonate 500 MG PO TID, Acetylsalicylic Acid 81 MG PO QD, Colace 100 MG PO BID, Prednisone 10 MG PO QAM, Sodium Bicarbonate 325 MG PO TID, Flovent 220 MCG INH BID, Bactrim DS, Plavix 75 MG PO QD, Esomeprazole 40 MG PO QD, Duoneb, Glipizide XL 2.5 MG PO QD, Vit. B-3, Lipitor 40 MG PO QD, Atorvastatin Calcium, Lovenox 50 MG SC QD, and Insulin Regular Human (Sliding Scale subcutaneously SC AC: if BS is 125-150, then give 2 units; if BS is 151-200, then give 3 units; if BS is 201-250, then give 4 units; if BS is 251-300, then give 6 units; if BS is 301-350, then give 8 units; if BS is 351-400, then give 10 units). She was discharged to Wadesdi Ckgart Community Hospital at a euvolemic state with a dry weight of 49kg, continuing on Lasix 80 PO BID unless Cr rises above new baseline of 3.5 or if she gains weight or shows signs of new overload, and Lovenox should be stopped once her INR is >2. Coumadin dose should be adjusted according to INR goal 2-3, and she should be on a renal diet with low potassium and low glucose but with diabetic caloric supplements like GLUCERNA. She should receive a HOT PACK to her neck 2-3x per day and to her vein before blood draw for comfort, physical therapy daily with the goal of gait stability, home safety, and good O2 sats on 2L O2, and VNA services for meds. She should follow up with PCP, renal, and cardiology, and return to the hospital or call doctor if she experiences worsening SOB, fever over 100.5, chest pain, decreased urine output, weight gain over 5 pounds, or any other concerning symptoms. The patient was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 500 MG PO TID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, IRON SULFATE (FERROUS SULFATE) 325 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, LASIX (FUROSEMIDE) 80 MG PO BID, HYDRALAZINE HCL 25 MG PO TID HOLD IF: SBP<90, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC AC, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO TID, DILANTIN (PHENYTOIN) 100 MG PO QID, POTENTIALLY SERIOUS INTERACTION: PHENYTOIN & WARFARIN, PREDNISONE 10 MG PO QAM, SODIUM BICARBONATE 325 MG PO TID, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, SERIOUS INTERACTION: SULFAMETHOXAZOLE & WARFARIN, MVI THERAPEUTIC (THERAPE | Is there a mention of of atorvastatin calcium usage/prescription in the record | {
"answer_end": [
1063
],
"answer_start": [
1042
],
"text": [
"Atorvastatin Calcium,"
]
} |
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. | Has the patient ever had ns | {
"answer_end": [
405
],
"answer_start": [
361
],
"text": [
"rose to 73/40 after 1 liter of NS was given."
]
} |
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. | When was isordil discontinued | {
"answer_end": [
1100
],
"answer_start": [
1039
],
"text": [
"We re-added his Isordil at 10 mg t.i.d. for the last 24 hours"
]
} |
76 year-old male with significant cardiac history, including NSTEMI and asystole arrest, presented with weakness, dizziness, and chest pain for 3 days, currently chest pain-free. EKG on admission showed subtle changes with <1 mm ST depression in lateral leads. Patient was given Acetylsalicylic Acid 325 mg PO QD, Ativan 0.5 mg x 1, Magnesium Chloride 500 mg x 1, Atenolol 25 mg PO QD, Atorvastatin 80 mg PO QD, Docusate Sodium 100 mg PO BID, Losartan 50 mg PO QD, Amlodipine 10 mg PO QD, Pantoprazole 40 mg PO QD, Lipitor (Atorvastatin) 80 mg PO daily, Colace (Docusate Sodium) 100 mg PO BID, Potassium Chloride IV, Potassium Chloride Immediate Release PO, Magnesium Gluconate (Magnesium Gluconate) 400 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, ASA 325 mg x 1, and MIBI ordered. Metformin was held and DM protocol was instituted while in house. Patient was at risk for cardiac event and was treated with BB and titrated as tolerated, with Tele monitoring. Nutrition consult was ordered due to recent decrease in appetite and FTT picture. SW was consulted and patient was discussed at length for services at home when discharged. Patient left AMA despite lengthy discussion about his health and risk for MI/death. Number of Doses Required (approximate): 3 for MG GLUCONATE (MAGNESIUM GLUCONATE) and 2 for TERAZOSIN HCL 1 MG PO DAILY. Home meds included ASA 325 mg daily, lipitor 80 mg daily, amlodipine 5 mg daily, protonix 40 mg daily, losartan 50 mg daily, and terazosin 1 mg daily. An override was added on 7/10/07 by KETCHAM, JAKE WALDO, M.D., PH.D. on order for KCL IV (ref # 687673059) with POTENTIALLY SERIOUS INTERACTION: LOSARTAN POTASSIUM & POTASSIUM CHLORIDE Reason for override: md aware, and on 11/8/07 by DERNIER, AUGUSTINE A., P.A.-C. on order for KCL IMMEDIATE RELEASE PO (ref # 856712835) with the same POTENTIALLY SERIOUS INTERACTION. Patient was instructed to resume regular exercise and to avoid grapefruit unless instructed otherwise. He was also given a diet of House/2gm Na/Carbohydrate Controlled/Low saturated fat low cholesterol. | lipitor | {
"answer_end": [
1425
],
"answer_start": [
1345
],
"text": [
"Home meds included ASA 325 mg daily, lipitor 80 mg daily, amlodipine 5 mg daily,"
]
} |
The patient is a 75-year-old female with a history of 2. Diabetes , on insulin, congestive heart failure, bilateral occipital CVAs, hypertension, chronic renal insufficiency, coronary artery disease, visual impair with tunnel vision, monoclonal gammopathy, and left upper extremity thrombophlebitis. She was found at home with altered mental status and a fingerstick of 37, which increased to 42 with orange juice and normalized her mental status. She was given 1. Lasix 80 mg p.o q.d. in the morning , 40 mg p.o. q.d. in the evening, 2. Atenolol 75 mg p.o. q.d., 3. Lipitor 10 mg p.o. q.d., 4. Amitriptyline 25 to 50 mg p.o. q.h.s. p.r.n., 5. Multivitamins., 6. Aspirin 325 mg p.o. q.d., 7. Folate 100 mg p.o. q.d., 8. Lisinopril 20 mg p.o. q.d., 9. Iron gluconate 325 mg p.o. t.i.d., 10. Novolin 34 to 40 units subcu. q.d., 11. Epogen 5000 units subcu. q. week., 6. Aspirin 325 mg p.o. q.d., 7. Colace 100 mg p.o. b.i.d., and 2. Metoprolol 12.5 mg p.o. b.i.d. Her NPH dose was cut to 20 units subcu. q.d. with lispro sliding scale q.a.c. and q.h.s., and Metoprolol was changed to Toprol as her blood pressure tolerates. Lisinopril was switched to captopril, then discontinued given her bumping which might suggest thalassemia. She is on iron and Epogen with Prophylaxis: Heparin and H2 blocker. Her minimally needed insulin was 5 units a day and her sugars were well controlled otherwise low. Lasix was decreased to 80 mg p.o. b.i.d. and the x-ray on the day of her discharge showed it was unlikely consolidated lobar pneumonia because of the improved forward flow from discontinuation of her ACE inhibitor. She was admitted with hypoglycemic diabetes possibly secondary to infection or logistical and social barriers, and was treated initially with levofloxacin for her right lower lobe pneumonia versus CHF, pleural effusion which decreased only minimally with diuresis of 1 to 2 liters overnight and for diagnostic and therapeutic purposes she underwent a thoracentesis on 2/11/05. Her chronic renal insufficiency was noted with creatinine at baseline of 2.6 and it decreased significantly on this admission possibly because of improved forward flow from discontinuation of her ACE inhibitor. She was on iron and Epogen with an improved hematocrit from the prior admission but no change in her MCV which suggests that she has more than renal disease causing her microcytosis. Her diabetc diet was low sodium, low fat, low cholesterol and prophylaxis included Heparin and H2 blocker. Her discharge medications included 1. Lasix 80 mg p.o. b.i.d., 2. Metoprolol 12.5 mg p.o. b.i.d., 3. Lipitor 10 mg p.o. q.d., 4. Amitriptyline 25 to 50 mg p.o. q.h.s. p.r.n., 5. Multivitamins, 6. Aspirin 325 mg p.o. q.d., 7. Folate 100 mg p.o. q.d., 8. Lisinopril 20 mg p.o. q.d., 9. Iron gluconate 325 mg p.o. t.i.d., and 10. Epogen 5000 units subcu. q. week. She was screened for admission to Jack Nor Medical Center Of where she will go today with intense physical therapy and learning greater independence in her daily functioning. Her pelvic films were negative for fracture. She should be ambulated t.i.d. with follow up with Dr. Rufener when she is able, Lasix dose can be increased as needed for better diuresis, and studies pending include cytology and culture of pleural fluid and follow-up chest x-ray on the day of her discharge. | Has the patient ever had iron | {
"answer_end": [
1296
],
"answer_start": [
1202
],
"text": [
"might suggest thalassemia. She is on iron and Epogen with Prophylaxis: Heparin and H2 blocker."
]
} |
The 64-year-old female patient was admitted with atypical chest pain and a history of CAD (NSTEMIs x 2 in 1997/2001, cath 2000 RCA, LCx in 2000, which were complicated by in-stent thrombosis ?3 years ago), HTN, DM (hba1c 6.2), PVD. In the ED, BP 159/69, P 60. No EKG changes new. First set of enzymes negative. D dimer negative. She underwent chemical-MIBI on 6/25 which was negative for any acute or reversible changes (final P). Her pain was only controlled with oxycodone and she was pain-free at discharge. Pt was discharged to home with follow-up already scheduled with Dr. Hassenger, her cardiologist at the end of the month. She was continued on ECASA (Aspirin Enteric Coated) 81 MG PO 3x/Week M-W-F, LISINOPRIL 1.25 MG PO QD (with POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL), PLAVIX (Clopidogrel) 75 MG PO QD, ATENOLOL 50 MG PO QD, LIPITOR (Atorvastatin) 40 MG PO QD, and GLYBURIDE 1.25 MG PO QD. Of note, pt had an elevated WBC (15.2) which seems to be chronic in nature. No fevers, localizing signs/symptoms of infection. Pt has follow-up with cardiology and vascular surgery scheduled. No new medications this admission. | Has the patient had previous atenolol | {
"answer_end": [
860
],
"answer_start": [
840
],
"text": [
"ATENOLOL 50 MG PO QD"
]
} |
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 | antibiotics history | {
"answer_end": [
1654
],
"answer_start": [
1590
],
"text": [
"Continue your antibiotics as long as you have a drain in place.,"
]
} |
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. | Has the patient ever been on albuterol | {
"answer_end": [
1103
],
"answer_start": [
1057
],
"text": [
"Toprol, lisinopril, albuterol, and famotidine."
]
} |
This is a 47-year-old female with a history of HIV, diabetes, questionable cerebral aneurysm, and seizure disorder who recently had two syncopal events without prodrome and without postictal state, who presented for evaluation of left arm paresthesias and chest pain, with associated diaphoresis, shortness of breath and nausea. Of note, the patient recently started Flexeril to treat chronic low back pain, was not receiving her Keppra for approximately a year, as her prescription had ran out, and was instead taking Ecotrin 81 mg daily, clonazepam 1 mg q.6 h. p.r.n., Imodium one to two tablets q.i.d. p.r.n. for diarrhea, and low-dose aspirin. The patient was started on low-dose beta-blocker and aspirin, metoprolol 12.5 b.i.d. with occasional bradycardia to the high 40's, and was treated with the Ryo Hospital Medical Center insulin protocol. The patient was restarted on Keppra 250 mg b.i.d. with a goal to increase to 500 mg b.i.d. after 7 days and to 750 mg after another week, and was given Keppra 500 mg b.i.d. for 14 doses and then 750 mg b.i.d., Flexeril 5 mg daily, clonazepam 1 mg q.i.d., Truvada one tablet p.o. daily, Norvir 1400 mg b.i.d., glyburide 5 mg q.a.m. and 2.5 mg q.p.m., Lomotil one tablet q.i.d. p.r.n., methadone 150 mg daily, Zofran 4 mg daily p.r.n., Percocet 325 mg/5 mg tablets one tablet q.6 h. p.r.n., Zantac 150 mg b.i.d., Zoloft 100 mg q.a.m., and trazodone 100 mg nightly. Labs revealed a low reticulocyte index consistent with anemia of chronic disease, and the methadone dose of 155 mg was confirmed with the outpatient clinic. The patient was also given three doses of Klonopin over a six-day period, instructed to take medications as listed, clarify discrepancies with her PCP, return to the ER for evaluation if she faints again, call her PCP and/or return to the ER if her chest pain symptoms recur and persist, make an appointment with the Smill Memorial Hospital to evaluate the cause of her left arm symptoms, and check her blood sugars before meals and at bedtime. Additionally, her PCP was instructed to arrange for a loop monitor, follow up on a 24-hour urine studies assessing for pheochromocytoma, and adjust the patient's diabetes management as needed. | What is the patient's current dose does the patient take of her lomotil | {
"answer_end": [
1233
],
"answer_start": [
1200
],
"text": [
"Lomotil one tablet q.i.d. p.r.n.,"
]
} |
Patient Mariano Librizzi was admitted on 4/21/2005 with a viral infection and severe pulmonary hypertension, and discharged on 9/22/2005 to go home. The discharge medications included ECASA (Aspirin Enteric Coated) 81 MG PO QD, with a potentially serious interaction with Warfarin & Aspirin, COLACE (Docusate Sodium) 100 MG PO BID, LASIX (Furosemide) 160 MG PO BID, GLIPIZIDE 10 MG PO BID, OCEAN SPRAY (Sodium Chloride 0.65%) 2 SPRAY NA QID, COUMADIN (Warfarin Sodium) 5 MG PO QPM, JERICH, JOSPEH, M.D. on order for ECASA PO (ref #91585860), ZOLOFT (Sertraline) 150 MG PO QD, AMBIEN (Zolpidem Tartrate) 10 MG PO QHS, KCL SLOW RELEASE 20 MEQ PO BID, ATROVENT NASAL 0.06% (Ipratropium Nasal 0.06%) 2 SPRAY NA TID, NEXIUM (Esomeprazole) 20 MG PO QD, TRACLEER (Bosentan) 125 MG PO BID, VENTAVIS 1 neb NEB Q3H Instructions: during wake hours, ALBUTEROL INHALER 2 PUFF INH Q4H PRN Shortness of Breath, Wheezing, home O2 (8L NC). The patient was also prescribed K-Dur 20 BID, Nexium 20, Lasix 160 BID, Tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft 100, MVI, Oceanspray 2 Spray NA QID, Ambien 10 QHS, Ventavis nebs Q3H, Albuterol Inhaler 2 puff INH Q4H, KCl Slow Release 20 MEQ PO BID, Colace 100 MG PO BID, Atrovent Nasal 0.06%. The diet was House/Low chol/low sat. fat and 4 gram Sodium and they were advised to do walking as tolerated, with serial enzymes/EKG to be continued and Lasix, KCl, ASA 81 also advised. The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien, and to avoid high Vitamin-K containing foods and to give on an empty stomach (give 1hr before or 2hr after food). The patient was followed by the AH service with ACEi, cephalopsporins, GERD nexium prophylaxis and Coumadin for pulmonary microclots on Bx in tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft. The discharge condition was satisfactory. | has there been a prior nexium | {
"answer_end": [
968
],
"answer_start": [
923
],
"text": [
"The patient was also prescribed K-Dur 20 BID,"
]
} |
This 54-year-old female with end-stage renal disease on hemodialysis had an apparent VFib arrest at hemodialysis and was admitted to the CCU after being intubated in the Vibay General Hospital ED. She was intubated, received amiodarone and dopamine, as her BP was low. An x-ray revealed diffuse bilateral opacities, possible pulmonary edema versus aspiration pneumonia, and an EKG showed normal sinus rhythm 100 beats per minute with no acute ST changes. Her first set of cardiac enzyme revealed a creatinine kinase of 116 and the MB fraction of 0.7 and troponin T of less than assay and lactate of 1.8. A fistulogram and angioplasty of her right AV fistula was performed on 9/14/06 with prednisone premedication but it was unsuccessful and therefore a left IJ tunneled dialysis catheter was inserted on 10/18/06 with the tip ending in the right atrium. HOME MEDICATIONS at the time of admission included amitriptyline 25 mg p.o. bedtime, enteric-coated aspirin 325 mg p.o. daily, enalapril 20 mg p.o. b.i.d., Lasix 200 mg p.o. b.i.d., Losartan 50 mg p.o. daily, Toprol-XL 200 mg p.o. b.i.d., Advair Diskus 250/50 one puff inhaler b.i.d., insulin NPH 50 units q.a.m. subcu and 25 units q.p.m. subcu, insulin lispro 18 units subcu at dinner time, Protonix 40 mg p.o. daily, sevelamer 1200 mg p.o. t.i.d., tramadol 25 mg p.o. q.6 h. p.r.n. pain. A bronchoscopy was performed on 9/14/06 with prednisone premedication but it was negative for aspiration. The patient had difficulty weaning from vent and was finally extubated on 0/22/06. She had a single set of coag-negative Staph positive blood cultures from Quinton catheter on 8/8/06 and was treated with vancomycin dose by renal levels. An Echo on 8/1/06 showed an EF of 60 to 65% with mild concentric left ventricular hypertrophy and no wall motion abnormalities. The patient was continued on telemetry and treated with her home dose of beta-blocker with good response and was gradually advanced to an oral diet with no signs of aspiration status post extubation. She was also given heparin subcutaneously and Nexium as prophylaxis. The patient is full code and will likely need rehab and is being screened by PT and OT and will likely be discharged to rehab when bed is available. | How often does the patient take losartan | {
"answer_end": [
1138
],
"answer_start": [
1063
],
"text": [
"Toprol-XL 200 mg p.o. b.i.d., Advair Diskus 250/50 one puff inhaler b.i.d.,"
]
} |
This is a 63-year-old female who presented with bilateral lower extremity edema, increasing shortness of breath, 3+ edema in the extremities, areas of erythematous and shiny shallow ulcerations, significant laboratory data of sodium 147, potassium 3.4, chloride 110, CO2 26, BUN 23, creatinine 1.6, and glucose 69, CBC significant for white count of 6.7, hematocrit 39.4, and platelets of 258, CK 432, troponin less than assay, BNP greater than assay, and D-dimer 50 and 69, chest x-ray showed decreased lung volumes with moderate cardiac enlargement, EKG showed sinus bradycardia with a rate of 59, axis of -36 and no acute changes. The patient has a history of congestive heart failure, deep venous thrombosis bilaterally with PE, acute renal failure, nephrotic syndrome, pneumonia, iron and folate deficiency anemia, paroxysmal atrial fibrillation with rapid ventricular response, nonsustained ventricular tachycardia, insulin-dependent diabetes mellitus, hypertension, cholesterol, chronic knee and back pain, arthroscopic knee surgery bilaterally, gastritis, benign colon polyps greater than 10, cataracts, and glaucoma. She was prescribed Lasix 120 mg p.o. b.i.d., Atenolol 50 mg p.o. q.d., Iron sulfate 300 b.i.d., Folate 1 mg q.d., NPH insulin 20 units q.d., Oxycodone 5 mg to 10 mg q.4-6h. p.r.n. pain., Senna, Multivitamins, Zocor 40 mg p.o. q.d., Norvasc 10 mg p.o. q.d., Accupril 80 mg p.o. q.d., Miconazole 2% topical b.i.d., Celexa 20 mg p.o. q.d., Avandia 8 mg p.o. q.d., Nexium 20 mg p.o. q.d., Albuterol p.r.n., aspirin as well as statin, a low-dose short-acting beta-blocker (Lopressor), an ACE inhibitor with this switched to captopril as a short-acting ACE inhibitor for a goal blood pressure of systolic of 120, an adenosine MIBI, runs of NSVT and Coumadin 5 mg p.o. q.h.s., folate and iron replacement, NPH 20 units for her known diabetes, Bactrim one tablet p.o. b.i.d. for 7 days, Celebrex and other antiinflammatory medications, Colace 100 mg p.o. b.i.d., Prozac 20 mg p.o. q.d., NPH human insulin 20 units subcu q.p.m., Zestril 30 mg p.o. q.d., Senna tablets 2 mg p.o. b.i.d., Aldactone 25 mg p.o. q.d., Multivitamins with minerals one tablet p.o. q.d., Toprol XL p.o. q.d., Imdur 30 mg p.o. q.d., Prednisolone acetate 0.125% one drop OU q.i.d., Albuterol inhaler 2 puffs inhaler q.i.d. p.r.n. wheezing., Miconazole nitrate powder topical b.i.d. p.r.n., Aspirin 81 mg p.o. q.d., and her creatinine continued to rise until 8/3/03, when it reached 2.7, diuresis was put on hold on 3/15/03 and 10/5/03, and her ACE inhibitor dose was halved on 10/5/03, in order to monitor her creatinine function, she was found to have a UTI with E. Coli that was sensitive to Bactrim and she was treated with Bactrim with resolution, for her chronic pain and arthritis, her Celebrex was held given her increased creatinine and she was given oxycodone p.r.n. for pain, joint exam revealed swollen PIP joints of both hands as well as marked swelling over both wrists, and an ANA test came back negative, she was continued on Celexa for depression, a goal INR of 2 to 3 was set for her Coumadin, which was restarted on 4/12/03 for known paroxys | Has the patient taken medication for iron-deficiency anemia | {
"answer_end": [
1824
],
"answer_start": [
1796
],
"text": [
"folate and iron replacement,"
]
} |
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. | Why was the patient on zyprexa | {
"answer_end": [
795
],
"answer_start": [
754
],
"text": [
"Haldol to contain agitation and delirium,"
]
} |
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. | What medications has the patient ever tried for anticoagulation prevention | {
"answer_end": [
578
],
"answer_start": [
525
],
"text": [
"heparin while starting anticoagulation with Coumadin."
]
} |
This 74-year-old gentleman with insulin-dependent diabetes mellitus, hypertension, and coronary artery disease presented with substernal chest pain on exertion and was admitted with T wave inversions in leads V3 and V4. Cardiac cath showed a 95% ostial LAD lesion, a 60% mid LAD lesion, an 80% distal LAD lesion, a 70% proximal D1 lesion, a 40% proximal circumflex lesion, a 90% ostial OM1 lesion, and a 100% proximal RCA lesion; he underwent CABG x3 with a Y graft, SVG1 connecting SVG2 to the LAD, SVG2 connecting the aorta to OM1, and SVG3 connecting to PDA. The patient is a Spanish-speaking only male who is neurologically intact, moving all extremities, getting in and out of bed, and very independent. He had a ventricular fibrillation arrest in the operating room due to an aprotinin reaction, necessitating open cardiac massage and requiring lidocaine and amiodarone use during the code. Medication on admission included Lopressor 50 mg p.o. t.i.d., Lisinopril 40 mg p.o. daily, Aspirin 325 mg p.o. daily, Hydrochlorothiazide/triamterene one tablet daily, Atorvastatin 80 mg p.o. daily, and Lantus 50 cc daily. The patient developed a deep sternal infection with E. coli and was started on Flagyl and Vancomycin for presumed aspiration pneumonia, Imipenem for ID's recommendation, and Nitrofurantoin and Ceftazidime for UTI. He is on Lopressor 25 mg q.6h, Amlodipine 5 mg b.i.d., Lasix 20 mg p.o. b.i.d., Aspirin, Atorvastatin, Lantus, NovoLog, and Diabetes Management. Imipenem and Vancomycin need to be continued for six weeks. He had a small area of erythema on his chest wound, but it is intact and he is being followed by Plastics. He had one brief episode of atrial fibrillation during a coughing spell, but it resolved and he is on antihypertensive medication. He was deemed fit for transfer back to the Step-Down Unit on postoperative day #18. | has the patient used nitrofurantoin. in the past | {
"answer_end": [
1333
],
"answer_start": [
1256
],
"text": [
"Imipenem for ID's recommendation, and Nitrofurantoin and Ceftazidime for UTI."
]
} |
RECORD #159637 was a 45-year-old male with multiple cardiac risk factors, including known CAD s/p MI (4/14 with PCI to LAD, complicated by instent thrombosis 1 week post-cath->successfully restented), HTN, dyslipidemia, obesity, and positive FHx who was admitted on 4/22/2003 with non-ischemic chest pain. He had an ETT-MIBI in 5/12 which showed large fixed defect in anterior, anteroseptal, anterolateral, inferior, LV apex with EF of 35%. On this occasion, he noted sudden onset of 8/10 chest pain while at rest at 6:30 pm on the evening of admission and was transported to Greena Hospital where his vitals were 98.2, 73, 92/62, 15. He was given IV TNG, heparin, MSO4, ASA with pain down to 4/10 and transferred to ITH. Ruling out ischemia by ensymes and ETT, the patient was discharged on 5/4/2003 with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Folic Acid 1 MG PO QD, Ativan (Lorazepam) 1 MG PO QHS, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain, Darvocet N 100 (Propoxyphene Nap./Acetaminophen) 1 TAB PO Q4H PRN Pain, Zocor (Simvastatin) 80 MG PO QHS, Norvasc (Amlodipine) 2.5 MG PO BID, Toprol XL (Metoprolol (Sust. Rel.)) 50 MG PO QD, Altace (Ramipril) 2.5 MG PO QD, Potassium Chloride IV (ref # 68076838) and Immed. Rel. PO (ref #) with Potentially Serious Interaction: Ramipril & Potassium Chloride, Clopidogrel 75 MG PO QD, Vioxx (Rofecoxib) 25 MG PO BID, Protonex (Pantoprazole) 40 MG PO QD, Diet: House/Low Chol/Low Sat. Fat, Activity: Resume Regular Exercise, Follow Up Appointments with Dr. Damon Krzeczkowski and Dr. Lon Willims, Allergy: Atarax (Hydroxyzine Hcl), Sulfa, Number of Doses Required (approximate): 3, and instructions to consider increasing CCB as patient seems to feel it helps his LH, dizziness and to adjust HTN meds as he was relatively hypotensive (SBP 90-110) in hospital (although asymptomatic) and outpatient cardiac rehabillitation. | What is the current dose of vioxx ( rofecoxib ) | {
"answer_end": [
1387
],
"answer_start": [
1356
],
"text": [
"Vioxx (Rofecoxib) 25 MG PO BID,"
]
} |
This 54-year-old male with ischemic cardiomyopathy, severe pulmonary hypertension, and chronic kidney disease (Cr 2.5) was admitted to MSCH 3 weeks ago for CHF and diuresis and volume resuscitated with creatinine decreasing to 3.9. He was discharged on 8/27/06 at 2:00 PM with a full code status and disposition to home with medications Aspirin Enteric Coated 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 10 MG PO DAILY, COLESTIPOL HYDROCHLORIDE 10 GM PO DAILY, INSULIN GLARGINE 14 UNITS SC DAILY, HUMALOG INSULIN (INSULIN LISPRO) Sliding Scale (subcutaneous) SC AC, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, KLOR-CON (KCL SLOW RELEASE) 20 MEQ PO DAILY (each 20 mEq dose to be given with 4 oz of fluid), TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO BEDTIME, TORSEMIDE 150 MG PO DAILY, metolazone on an as-needed basis for weight, but presented to ED with Cr 5.1, ZEMPLAR 1MG DAILY, Klorcon slow release 20 mEq daily, Flomax 0.4 qd, colestipol 1g qd, toprol-XL 50 qhs, lantus 14 unit sc, humalog scale, and metolazone 5mg as needed with the instructions to take Torsemide and Klor-Con as per his normal routine and to take Flomax, Colestipol, and Toprol-XL consistently with meals or on an empty stomach, and to continue his home medications otherwise. The patient was also advised to return Monday for his second dialysis run and not take Torsemide on Monday with a Number of Doses Required (approximate): 5. | has the patient had humalog insulin ( insulin lispro ) | {
"answer_end": [
560
],
"answer_start": [
492
],
"text": [
"HUMALOG INSULIN (INSULIN LISPRO) Sliding Scale (subcutaneous) SC AC,"
]
} |
This is a 63-year-old female who presented with bilateral lower extremity edema, increasing shortness of breath, 3+ edema in the extremities, areas of erythematous and shiny shallow ulcerations, significant laboratory data of sodium 147, potassium 3.4, chloride 110, CO2 26, BUN 23, creatinine 1.6, and glucose 69, CBC significant for white count of 6.7, hematocrit 39.4, and platelets of 258, CK 432, troponin less than assay, BNP greater than assay, and D-dimer 50 and 69, chest x-ray showed decreased lung volumes with moderate cardiac enlargement, EKG showed sinus bradycardia with a rate of 59, axis of -36 and no acute changes. The patient has a history of congestive heart failure, deep venous thrombosis bilaterally with PE, acute renal failure, nephrotic syndrome, pneumonia, iron and folate deficiency anemia, paroxysmal atrial fibrillation with rapid ventricular response, nonsustained ventricular tachycardia, insulin-dependent diabetes mellitus, hypertension, cholesterol, chronic knee and back pain, arthroscopic knee surgery bilaterally, gastritis, benign colon polyps greater than 10, cataracts, and glaucoma. She was prescribed Lasix 120 mg p.o. b.i.d., Atenolol 50 mg p.o. q.d., Iron sulfate 300 b.i.d., Folate 1 mg q.d., NPH insulin 20 units q.d., Oxycodone 5 mg to 10 mg q.4-6h. p.r.n. pain., Senna, Multivitamins, Zocor 40 mg p.o. q.d., Norvasc 10 mg p.o. q.d., Accupril 80 mg p.o. q.d., Miconazole 2% topical b.i.d., Celexa 20 mg p.o. q.d., Avandia 8 mg p.o. q.d., Nexium 20 mg p.o. q.d., Albuterol p.r.n., aspirin as well as statin, a low-dose short-acting beta-blocker (Lopressor), an ACE inhibitor with this switched to captopril as a short-acting ACE inhibitor for a goal blood pressure of systolic of 120, an adenosine MIBI, runs of NSVT and Coumadin 5 mg p.o. q.h.s., folate and iron replacement, NPH 20 units for her known diabetes, Bactrim one tablet p.o. b.i.d. for 7 days, Celebrex and other antiinflammatory medications, Colace 100 mg p.o. b.i.d., Prozac 20 mg p.o. q.d., NPH human insulin 20 units subcu q.p.m., Zestril 30 mg p.o. q.d., Senna tablets 2 mg p.o. b.i.d., Aldactone 25 mg p.o. q.d., Multivitamins with minerals one tablet p.o. q.d., Toprol XL p.o. q.d., Imdur 30 mg p.o. q.d., Prednisolone acetate 0.125% one drop OU q.i.d., Albuterol inhaler 2 puffs inhaler q.i.d. p.r.n. wheezing., Miconazole nitrate powder topical b.i.d. p.r.n., Aspirin 81 mg p.o. q.d., and her creatinine continued to rise until 8/3/03, when it reached 2.7, diuresis was put on hold on 3/15/03 and 10/5/03, and her ACE inhibitor dose was halved on 10/5/03, in order to monitor her creatinine function, she was found to have a UTI with E. Coli that was sensitive to Bactrim and she was treated with Bactrim with resolution, for her chronic pain and arthritis, her Celebrex was held given her increased creatinine and she was given oxycodone p.r.n. for pain, joint exam revealed swollen PIP joints of both hands as well as marked swelling over both wrists, and an ANA test came back negative, she was continued on Celexa for depression, a goal INR of 2 to 3 was set for her Coumadin, which was restarted on 4/12/03 for known paroxys | Was the patient on any medication for her pain | {
"answer_end": [
1312
],
"answer_start": [
1267
],
"text": [
"Oxycodone 5 mg to 10 mg q.4-6h. p.r.n. pain.,"
]
} |
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty. | has the patient used insulin in the past | {
"answer_end": [
457
],
"answer_start": [
383
],
"text": [
"She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine,"
]
} |
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks. | Was the patient on any medication for her tremor | {
"answer_end": [
1323
],
"answer_start": [
1267
],
"text": [
"he has a history of tremor and is treated with Primidone"
]
} |
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage. | What uti. meds has vet tried in past | {
"answer_end": [
3263
],
"answer_start": [
3195
],
"text": [
"will stay and finish the 14-day course of Levaquin for UTI coverage."
]
} |
This 70-year-old woman with a complex medical history, including cerebrovascular accident x two in 1980s without deficits, seizure history probably secondary to ETOH withdrawal, hypertension x 30 years, asthma, gout, and status post repair of subclavian artery stenosis in 1993, presented to the Dagha Medical Center with severe chest pain. A chest CT revealed a 2.3 x 2.8 cm lobulated mass in the right lower lobe involving the pleura, with extensive hilar and mediastinal constitutions consistent with prior granulomatous disease, and tests were positive for multiple precarinal and right peritracheal areas of adenopathy recent from metastatic disease. The patient was admitted to the Thoracic Surgery Service on 3/27/99 and taken to the Operating Room for a video assisted thorascopic right lower lobe lobectomy by Dr. Minick. Postoperatively, the patient did well, with no complications, and was followed by the Internal Medicine Service. The patient went into rapid atrial fibrillation postoperatively, and was successfully converted into a normal sinus rhythm using Diltiazem IV, which was converted to p.o. Diltiazem. The patient's postoperative course was largely unremarkable but for dysrhythmia, and the patient's pain was well controlled with p.o. pain medications, Percocet. Final pathology was read as squamous cell carcinoma, 4.0 cm., moderately differentiated with focal characterization with extensive necrosis. The patient was discharged to home with medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d., Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d., Dyazide 25 mg q.d., nose spray b.i.d., calcium chloride pills q.d., Colchicine 600 mg q.d., cyproheptadine hydrochloride 4 mg b.i.d. q.h.s., anticholesterol med., Albuterol nebulizers 250 mg q.4h., Allopurinol 300 mg q.d., Colchicine 0.6 mg q.d., cyproheptadine hydrochloride by mouth 400 mg q.d., Digoxin 0.125 mg q.d., Diltiazem 30 mg t.i.d., Colace 100 mg t.i.d., Lasix 40 mg p.o. q.d., Percocet 1-2 tablets p.o. q.4h. p.r.n., Dilantin 200 mg p.o. b.i.d., and Trazodone 100 mg p.o. q.h.s., with follow-up with Thoracic Surgery Service as well as with primary care physician and Cardiology as needed. | What is the current dose of trazodone | {
"answer_end": [
1662
],
"answer_start": [
1595
],
"text": [
"Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d.,"
]
} |
A 59 year-old woman with metastatic breast cancer and a history of pulmonary embolism presented with symptoms of fatigue, lethargy, tachycardia and fever. CXR showed LLL opacity, LUL opacity and hilar fullness on the right with prominent bronchi (?cuffing) and vertebral fractures. She was admitted with bacteremia on 7/0/2006 and treated with whole brain radiotherapy in March 2006 and with weekly Taxol. Restaging studies showed stable visceral disease but progression of bony metastatic disease, so in January 2006, she initiated a second-line Navelbine therapy. At the ER, she was administered 1UPRBC, 1L NS, Levofloxacin 500 mg IV, and placed CVP~20. Her blood pressure systolic initially 120s but decreased to 90s (MAPS>70), and norepinephrine was administered. She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN Pain, Temperature greater than:101, Other:transfusion premedication, ALBUTEROL NEBULIZER 2.5 MG INH Q4H PRN Wheezing, TESSALON PERLES (BENZONATATE) 100 MG PO TID PRN Other:congestion, BENADRYL (DIPHENHYDRAMINE) 12.5 MG PO x1 PRN Other:pre-transfusion, COLACE (DOCUSATE SODIUM) 100 MG PO BID PRN Constipation, ENOXAPARIN 40 MG SC DAILY, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, FLOVENT HFA (FLUTICASONE PROPIONATE) 110 MCG INH BID, INSULIN ASPART Sliding Scale. | What medications did the patient take for Other:transfusion premedication | {
"answer_end": [
829
],
"answer_start": [
768
],
"text": [
"She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN Pain,"
]
} |
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. | What is the current dose of the patient's lasix | {
"answer_end": [
1376
],
"answer_start": [
1338
],
"text": [
"potassium chloride 20 mEq p.o. 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 the patient had multiple vicodan prescriptions | {
"answer_end": [
1002
],
"answer_start": [
940
],
"text": [
"He was also prescribed Vicodan one to two p.o. q.3-4h. p.r.n.,"
]
} |
Ms. Halnon is a 67-year-old female with multiple medical comorbidities and a past medical history significant for cardiac transplant in 1993, and hip replacement in July 2005, complicated by wound infection, and need for prolonged rehabilitation who presented from Port Medical Center to Ephma Mersources Ni Memorial Hospital with three days of progressive worsening shortness of breath. Upon admission, her mental status was borderline, but it improved with discontinuation of standing analgesic and decreasing of her clonazepam. A head CT showed no acute processes. She had a right upper arm cellulitis and urinary tract infection on screening urinalysis. She was anemic and was found to be vancomycin resistant Enterococcus positive, but repeated cultures demonstrated MRSA negative. For her heart failure, she was diuresed with IV and transitioned to oral torsemide and they entered discharge dose of torsemide 200 mg p.o. twice per day. She was given a five-day course of levofloxacin (used to address recurrent UTI) and then a two-day course of Ancef, her cellulitis was initially treated with levofloxacin and transitioned to Bactrim based on antibiogram sensitivities. A long-term Foley was placed for comfort with catheter in place. While on Bactrim for her UTI, her creatinine rose from 1.5 to 1.6, but cleared with this regimen. For her chronic anemia, the patient was continued on iron (which was increased to three times per day) and darbepoetin, folate was added. She was asymptomatic from her chronic anemia. She was given two units of packed red blood cells in March, 2005, and two more units on February, 2006. Her admission weight was 133 kg and her creatinine was 1.6. At discharge, she was hemodynamically stable, afebrile, and breathing comfortably on three liters of oxygen. Her discharge medications included Vitamin C 500 mg twice per day, Imuran 25 mg daily, PhosLo 667 mg three times per day, clonazepam 0.25 mg twice daily, iron sulfate 325 mg three times per day, folate 1 mg daily, Dilaudid 2 mg every six hours as needed for pain, lactulose 30 mL four times per day as needed for constipation, prednisone 5 mg every morning, Sarna topical every day apply to affected areas, multivitamin daily, Coumadin 2.5 mg daily, goal INR 2 to 3, zinc sulfate 220 mg daily, Ambien 5 mg before bed as needed for insomnia, torsemide 200 mg by mouth two times per day, cyclosporine 50 mg twice daily, Colace 100 mg twice daily, insulin NPH 14 units every evening, insulin NPH 46 units every morning, esomeprazole 20 mg once per day, DuoNeb 3/0.5 mg inhaled every six hours as needed for shortness of breath, Aranesp 50 mcg subcutaneously once per week, NovoLog sliding scale before meals, Lexapro 20 mg once per day, Maalox one to two tablets every six hours as needed for upset stomach, and Lipitor 20 mg once per day. Outstanding issues include following INR the goal of 2 to 3, following weight and clinical signs of volume overload, following up on loose stools for possible Clostridium difficile infection, and following clinical signs for evidence of urinary tract infection treating with antibiotics as necessary. | Has this patient ever been treated with zinc sulfate | {
"answer_end": [
2337
],
"answer_start": [
2224
],
"text": [
"Coumadin 2.5 mg daily, goal INR 2 to 3, zinc sulfate 220 mg daily, Ambien 5 mg before bed as needed for insomnia,"
]
} |
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. | Is the patient currently or have they ever taken kcl | {
"answer_end": [
1050
],
"answer_start": [
978
],
"text": [
"F/E/N: KCl PO replacement scale. MgSulfate sliding scale.GI: Colace PRN,"
]
} |
Mr. Mauras is a 72-year-old man with history of stable angina, type 2 diabetes, peripheral vascular disease, former smoking history, and history of seizure disorder with cataracts. He had occasional anginal symptoms prior to discharge and took about two nitroglycerins per week. Over the past week, he had escalating chest pain requiring one nitroglycerin per day. The pain was relieved by rest and nitroglycerin. One week prior to admission, his digoxin was stopped and his amiodarone was decreased. His Plavix was stopped and his Coumadin was held. On the morning of admission, he had chest pain and received Lopressor, Enalapril, Lovenox treatment dose and a Plavix load in the ED. He was found to have flash pulmonary edema and in atrial fibrillation with rapid ventricular response and was taken back to the catheterization lab and given four stents to his saphenous vein graft, OM1 with good resolution of his symptoms. He was transferred to the floor and was given an amiodarone load given his ejection fraction and increased ectopy on telemetry. His troponin had been trended down to the 0.2s by discharge and his beta-blocker and ACE inhibitor were titrated to heart rate and blood pressure. Prior to anticipated discharge, he re-developed flash pulmonary edema secondary to atrial fibrillation with rapid ventricular response and was re-loaded with digoxin. He was started on Mucomyst precath with good effect, had a difficult-to-place Foley, and was started on Flomax with good effect. His creatinine on discharge was 1.2, his metformin was held, and he was continued on Lantus with sliding scale insulin. He was given three units of packed red blood cells given his history of CAD and was prescribed with Amiodarone 200 mg, Enteric-coated aspirin 325 mg, Librium 10 mg, Colace 200 mg, Ferrous gluconate 324 mg, Lasix 40 mg, Nitroglycerin one tab, Dilantin 100 mg, Senna two tabs, Coumadin 3 mg, Lipitor 80 mg, Flomax 0.4 mg, Plavix 75 mg, Lantus 14 units, Metformin 500 mg, Ranitidine 150 mg, Digoxin 0.125 mg, Enalapril 10 mg, and Atenolol 50 mg, with follow-up appointments with his PCP, Dr. Kelley Hernon of Electrophysiology on 7/8/05, and Dr. Daft on 9/20/05, and INR checked on 8/4/05 or 7/8/05 with Coumadin adjusted accordingly. | Has the patient had multiple digoxin prescriptions | {
"answer_end": [
500
],
"answer_start": [
443
],
"text": [
"his digoxin was stopped and his amiodarone was decreased."
]
} |
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs. | What is the dosage of the medication the patient was prescribed for aspiration pneumonia. | {
"answer_end": [
1580
],
"answer_start": [
1497
],
"text": [
"He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia,"
]
} |
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