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This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic. | How much lopressor does the patient take per day | {
"answer_end": [
844
],
"answer_start": [
816
],
"text": [
"Lopressor 25 mg p.o. b.i.d.,"
]
} |
EVANKO, BENEDICT 205-94-27-9, a 66-year-old Spanish-speaking male was admitted with chest pressure initially on exertion, most recently at rest, for which he took two nitroglycerin tablets with good resolution and worsening lower extremity edema and a 30-pound weight gain over the past few months due to missing his medications and eating a lot of salt. On examination, he was afebrile with HR in the 60s and BP 110/100% RA. Tests performed revealed pulmonary edema on CXR. He was prescribed Acetylsalicylic Acid 81 mg PO daily, Atorvastatin 80 mg PO daily, Coreg (Carvedilol) 3.125 mg PO BID, Plavix (Clopidogrel) 75 mg PO daily, Lasix (Furosemide) 80 mg PO daily starting in the morning, Insulin 70/30 Human 50 units QAM and 35 units QPM SC, Imdur ER (Isosorbide Mononitrate (SR)) 30 mg PO daily, hold Lisinopril 10 mg PO daily if SBP < 90, Potentially serious interaction: Spironolactone 50 mg PO daily, hold if SBP < 90, Potentially serious interaction: Potassium Chloride &, Metamucil Sugar Free (Psyllium (Metamucil) Sudafed) 1 packet PO daily, KCL Immediate Release PO, Potassium Chloride Immediate Release PO, Captopril PO, Insulin Aspart Sliding Scale (subcutaneously) SC AC, If BS is < 125, then give 0 units subcutaneously, Lipitor 80, Lovenox 100 sq., ACEi started and increased to 10mg QD, NPH 18 BID (increased from home 10), 6U AC and SS, Hgb A1C 10.4 indicating need for tighter glucose control, Diuresed well with weight on DC of 82kg, Sinus with long PR interval, Cardiogenic Pulm Edema, Mild Transaminitis decreased, Alk Phos continues to be elevated at 175, Left Foot Pain, Degenerative Changes. He was started on Lasix 80 IV, Acetylsalicylic Acid 81 mg PO daily, Atorvastatin 80 mg PO daily, Coreg (Carvedilol) 3.125 mg PO BID, Plavix (Clopidogrel) 75 mg PO daily, Lasix (Furosemide) 80 mg PO daily starting in the morning, Insulin 70/30 Human 50 units QAM and 35 units QPM SC, Imdur ER (Isosorbide Mononitrate (SR)) 30 mg PO daily, Lisinopril 10 mg PO daily (hold if SBP<90), and Spironolactone 50 mg PO daily (hold if SBP<90), Potentially Serious Interaction: Potassium Chloride &, Potentially Serious Interaction: Spironolactone &, Insulin Aspart Sliding Scale (subcutaneously) SC AC, and Metamucil Sugar Free (Psyllium (Metamucil) Sugar Free) 1 packet PO daily, Potassium Chloride Immediate Release PO (ref #). He was free of chest pain since Sunday and was discharged with fluid restriction, a low-chol/low-sat fat diet, 2 gram Sodium diet, and walking as tolerated, and was advised to take all his medications as directed, adjust insulin as needed, and check his blood sugars in the morning and with meals, and keep tight control over his blood sugar. He was also scheduled for follow-up appointments with Cardiology Dr. Lelonek 714.815.2497 1-4 weeks and PCP Dr. Hoyt Shimek 556-913-5202 2 weeks. | Was the patient ever prescribed lisinopril | {
"answer_end": [
843
],
"answer_start": [
805
],
"text": [
"Lisinopril 10 mg PO daily if SBP < 90,"
]
} |
Ms. Halnon is a 67-year-old female with multiple medical comorbidities and a past medical history significant for cardiac transplant in 1993, and hip replacement in July 2005, complicated by wound infection, and need for prolonged rehabilitation who presented from Port Medical Center to Ephma Mersources Ni Memorial Hospital with three days of progressive worsening shortness of breath. Upon admission, her mental status was borderline, but it improved with discontinuation of standing analgesic and decreasing of her clonazepam. A head CT showed no acute processes. She had a right upper arm cellulitis and urinary tract infection on screening urinalysis. She was anemic and was found to be vancomycin resistant Enterococcus positive, but repeated cultures demonstrated MRSA negative. For her heart failure, she was diuresed with IV and transitioned to oral torsemide and they entered discharge dose of torsemide 200 mg p.o. twice per day. She was given a five-day course of levofloxacin (used to address recurrent UTI) and then a two-day course of Ancef, her cellulitis was initially treated with levofloxacin and transitioned to Bactrim based on antibiogram sensitivities. A long-term Foley was placed for comfort with catheter in place. While on Bactrim for her UTI, her creatinine rose from 1.5 to 1.6, but cleared with this regimen. For her chronic anemia, the patient was continued on iron (which was increased to three times per day) and darbepoetin, folate was added. She was asymptomatic from her chronic anemia. She was given two units of packed red blood cells in March, 2005, and two more units on February, 2006. Her admission weight was 133 kg and her creatinine was 1.6. At discharge, she was hemodynamically stable, afebrile, and breathing comfortably on three liters of oxygen. Her discharge medications included Vitamin C 500 mg twice per day, Imuran 25 mg daily, PhosLo 667 mg three times per day, clonazepam 0.25 mg twice daily, iron sulfate 325 mg three times per day, folate 1 mg daily, Dilaudid 2 mg every six hours as needed for pain, lactulose 30 mL four times per day as needed for constipation, prednisone 5 mg every morning, Sarna topical every day apply to affected areas, multivitamin daily, Coumadin 2.5 mg daily, goal INR 2 to 3, zinc sulfate 220 mg daily, Ambien 5 mg before bed as needed for insomnia, torsemide 200 mg by mouth two times per day, cyclosporine 50 mg twice daily, Colace 100 mg twice daily, insulin NPH 14 units every evening, insulin NPH 46 units every morning, esomeprazole 20 mg once per day, DuoNeb 3/0.5 mg inhaled every six hours as needed for shortness of breath, Aranesp 50 mcg subcutaneously once per week, NovoLog sliding scale before meals, Lexapro 20 mg once per day, Maalox one to two tablets every six hours as needed for upset stomach, and Lipitor 20 mg once per day. Outstanding issues include following INR the goal of 2 to 3, following weight and clinical signs of volume overload, following up on loose stools for possible Clostridium difficile infection, and following clinical signs for evidence of urinary tract infection treating with antibiotics as necessary. | Has the patient taken medication for her chronic anemia | {
"answer_end": [
1459
],
"answer_start": [
1364
],
"text": [
"the patient was continued on iron (which was increased to three times per day) and darbepoetin,"
]
} |
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic. | Has this patient ever been on diuril | {
"answer_end": [
625
],
"answer_start": [
589
],
"text": [
"transition from Zaroxolyn to Diuril,"
]
} |
The patient, Emile Daron 493-31-10-1, was admitted on 3/17/2003 for pancreatitis with a Discharge Date of 2/1/2003 and was placed on a Full Code status and discharged to Home. She had a definite allergy (or sensitivity) to muscle relaxants, skeletal, and possible allergy (or sensitivity) to sulfa. The patient is a 64-year-old with known CAD, atherosclerotic peripheral vascular disease, and type 2 diabetes who presented with 8/10 stabbing back pain 4 days ago without a clear precipitant, which was non-raditating and partially relieved with analgesics. She denied any bowel or bladder incontinence or saddle anesthes ia, fevers, chills, nausea, vomiting, or diarrhea, however she did complain of urinary frequency (on lasix) in the last few days with out any dysuria or urgency. The patient also has increasing shortness of breath over the past month and abdominal distension over the last month, as well as intermittent left sided chest pain that radiates to her left arm. In the ED the patient was ruled out for an aortic dissection, MI, and had a negative D-Dimer, however lipase levels were elevated with normal LFTs. The patient had poor glucose control and her LDL was 151 and her triglycerides were very high, which could be a cause of her pancreatitis. The patient was placed on a House/Adv. as tol. / ADA 1800 cals/day / Very low fat (20gms/day) diet and was encouraged to resume regular exercise. Discharge medications included ACETYLSALICYLIC ACID 81 MG PO QD, AMITRIPTYLINE HCL 30 MG PO QHS, PREMARIN (CONJUGATED ESTROGENS) 0.625 MG PO QD, FLEXERIL (CYCLOBENZAPRINE HCL) 10 MG PO TID PRN Pain, COLACE (DOCUSATE SODIUM) 100 MG PO BID, FLUOXETINE (FLUOXETINE HCL) 40 MG PO QD, GEMFIBROZIL 600 MG PO BID with SERIOUS INTERACTION: SIMVASTATIN & GEMFIBROZIL, NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 10 UNITS SC QAM and NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 50 UNITS SC QHS, LORAZEPAM 1 MG PO QD, AMLODIPINE 10 MG PO QD Food/Drug Interaction Instruction, TOPROL XL (METOPROLOL (SUST. REL.)) 100 MG PO QD, IRBESARTAN 300 MG PO QD, LASIX (FUROSEMIDE) 40 MG PO QD, and LIPITOR (ATORVASTATIN) 80 MG PO QD with SERIOUS INTERACTION: GEMFIBROZIL & ATORVASTATIN CALCIUM, and was instructed to take consistently with meals or on empty stomach and to avoid grapefruit unless MD instructs otherwise. Follow up appointments included Dr. Bouy, vascular surgery, U Daylis Ont, 12:50 pm, Dr. Blaine Wehrley, 11:30 AM 5/14/03, MRI/A of abdomen, SHS Re Na, New Hampshire 59460, 11:20 AM, and Dr. Colleen on 10/2. We changed ATENOLOL to TOPROL XL 100 MG PO QD and AMLODIPINE 10 MG PO QD with Food/Drug Interaction Instruction. Endocrine- Has had poor glucose control. HbA1c 13. We continued NPH HUMULIN INSULIN 10 UNITS SC QAM and started AM NPH as well. Number of Doses Required (approximate): 5. Please take insulin in the morning as well as the night, and ask Dr. Colleen to help with your insulin regimen. | Has patient ever been prescribed gemfibrozil | {
"answer_end": [
1716
],
"answer_start": [
1691
],
"text": [
"GEMFIBROZIL 600 MG PO BID"
]
} |
Dewey Wittie, a 54 year old Hispanic female with morbid obesity, hypertension, non-insulin dependent diabetes mellitus, and sleep apnea on CPAP, was admitted to the MED service on 8/14/2006 for atypical chest pain. An ETT was performed in the ED with an EF of 55%, not in failure, and htn was controlled with BB and ACEI. She presented with one week history of intermittent left arm pain while washing dishes, lasting 15 minutes, sometimes radiating to her left chest, positional, not associated with shortness of breath, nausea, or vomiting. She responded to sublingual nitroglycerin (within 5-10 minutes) and her first set of cardiac enzymes is negative. She received aspirin and heparin gtt was started. Her home medications included Atenolol 50AM/25PM, Avadia 8, Fluoxetine 20, Metformin 1gm BID, Glyburide 10BID, Lisinopril 20, CaCO3 1200QD, and Amitriptyline 50QHS. She completed a ROMI and exercise tolerance test, which she walked for 2 minutes and 33 seconds at 75% maximum predicted heart rate, and stopped due to fatigue with no EKG changes. She was discharged stable with instructions to follow up with an A1C and lipid profile, and to pursue weight reduction. She was advised to resume regular exercise and make a follow up appointment with their primary care provider. The discharge medications included AMITRIPTYLINE HCL 50 MG PO BEDTIME, ENTERIC COATED ASPIRIN (ASPIRIN ENTERIC COATED) 81 MG PO DAILY, ATENOLOL 50 MG QAM; 25 MG QPM PO 50 MG QAM 25 MG QPM, CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY, FLUOXETINE HCL 20 MG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: o, METFORMIN 1,000 MG PO BID, AVADIA 8 UNIT DAILY, and GLYBURIDE 10 MG PO BID. The patient was warned about a potentially serious interaction between lisinopril and potassium chloride. The patient's diet was house/low chol/low sat. fat and ADA 1800 cals/dy, with 4 gram sodium. | What is the current dose of the patient's amitriptyline hcl | {
"answer_end": [
1353
],
"answer_start": [
1318
],
"text": [
"AMITRIPTYLINE HCL 50 MG PO BEDTIME,"
]
} |
GOMEY , REGGIE 802-36-83-4, a 70-year-old female with known CAD, DM, and schzioaffective disorder, presented with intermittent chest pain for 12 hours, with diaphoresis and no nausea/vomiting/fever/cough/shortness of breath. She had a recent cardiac workup with a moderate defect in the circumflex, but decided against medical treatment. Upon discharge, the patient was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, ATENOLOL 12.5 MG PO QAM HOLD IF: SBP<100 or HR<50, LIPITOR (ATORVASTATIN) 80 MG PO DAILY, COGENTIN (BENZTROPINE MESYLATE) 1 MG PO QAM, THORAZINE (CHLORPROMAZINE HCL) 400 MG PO QAM (on order, ref # 417100958) with a potentially serious interaction with Benztropine Mesylate and Chlorpromazine HCL, ECASA 325 MG PO DAILY, GLIPIZIDE XL 10 MG PO DAILY, SYNTHROID (LEVOTHYROXINE SODIUM) 100 MCG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP<100, METFORMIN 1,000 MG PO BID HOLD IF: NPO, and TRAZODONE 50 MG PO BEDTIME PRN Insomnia. CVD ROMI x2 with troponin and ck and CKMB were normal and the patient continued her cardiac medications for BP control and ECG showed early R wave but no ST changes. DM was managed with oral hypoglycemics and the patient was prescribed Heparin for prophylaxis. She was also prescribed a diet of House/Low chol/low sat. fat and 2 gram Sodium and given instructions to walk as tolerated. Follow up appointments were scheduled with Dr. Mike Kalafarski on 10/1/06. | Has the patient ever had hypoglycemics | {
"answer_end": [
1152
],
"answer_start": [
1114
],
"text": [
"DM was managed with oral hypoglycemics"
]
} |
Patient TEWA, GERMAN M, a 74-year-old African American female with a history of NYHA III CHF (EF 45%), PHT, HTN-CMP, and obesity, was admitted to CAR service on 1/20/2005 for CHF exacerbation and UTI and was discharged on 4/28/2005 with Full Code status. She was prescribed ALLOPURINOL 100 MG PO BID, FERROUS SULFATE 325 MG PO QD, LASIX (FUROSEMIDE) 60 MG PO BID starting today (8/27), HYDRALAZINE HCL 10 MG PO TID (hold if SBP below 90), ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID (hold if SBP below 90), LISINOPRIL 20 MG PO QD (hold if SBP below 90), LIPITOR (ATORVASTATIN) 10 MG PO QD, PROTONIX (PANTOPRAZOLE) 40 MG PO QD, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, LEVAQUIN (LEVOFLOXACIN) 250 MG PO QD, and ACETYLSALICYLIC ACID 325 MG PO QD. Override notices were added on 5/12/05, 10/29/05, and 10/29/05 on order for KCL IMMEDIATE RELEASE PO (ref #03030471, 01642329, 91907761, 15927551) and KCL IV (ref #78178294) for POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE. Food/Drug Interaction Instruction to avoid milk and antacid, take consistently with meals or on empty stomach, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose (if on tube feeds, please cycle (hold 1 hr before to 2 hr after) and take 2 hours before or 2 hours after dairy products) was provided, as well as fluid restriction and diurese aggressively with lasix 100 bid, replete lytes, keeping in mind CRI, cont BB, ACEI, and added hydralazine/isordil for CAD, hyperlipidemia: BB, ACEI, statin, ASA; RENAL: CRI with anemia; HEME: Anemia - Given aranesp, FeSO4; HTN: BB, ACEI; ID: UTI, E coli in Ucx, sensitivities pending; and empirically tx with Keflex, changed empirically on HD4 to levo. RHEUM: Gout - allopurinol. The patient was discharged in a satisfactory condition. | Has this patient ever been on levaquin (levofloxacin) | {
"answer_end": [
727
],
"answer_start": [
690
],
"text": [
"LEVAQUIN (LEVOFLOXACIN) 250 MG PO QD,"
]
} |
Ms. Hesby is a 36-year-old woman with very poorly controlled type 1 diabetes, end-stage renal disease, right eye blindness, lower extremity neuropathy, gastroparesis, and a history of extensive infections. She presented to Path Community Hospital with a right thigh burn and infection, and was given a prescription for antibiotics, 20 units of IV insulin, 500 mL normal saline boluses, and several 250 mL boluses, as well as 2 amps of calcium gluconate, Kayexalate, albuterol nebs, and Augmentin and IV vancomycin for her right thigh cellulitis. For long-term management, she was prescribed Lantus 24 units subcu each night, NovoLog sliding scale, PhosLo, Nephrocaps, Vitamin D, Sevelamer 1600 t.i.d., Toprol 100 mg p.o. daily, Lisinopril 5 mg p.o. daily, Plavix 75 mg p.o. daily, Keppra 500 mg p.o. b.i.d., Flovent two puffs b.i.d., Albuterol p.r.n., Baclofen 5 mg p.o. t.i.d., and Ambien 10 mg p.o. at bedtime p.r.n. The patient was admitted with a diagnosis of Diabetic Ketoacidosis (DKA) and was stabilized in the MICU on an insulin waves. She was then transitioned to NPH and finally to Lantus 24 units subcu and her hypertension is being managed on her home dose of Lopressor 25 q.i.d. and switched to Captopril, which is being titrated. Her area of cellulitis has completely resolved, and if she becomes acidotic, the patient can be managed with sodium bicarbonate and D5W in small boluses. The patient is taking her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d., however she has consistently refused her heparin. Of note, on the night of 1/26/06, the patient complained of severe cramping, right lower quadrant pain, which is new. She noted this pain has increased rapidly in the setting of diarrhea. Several C. diff studies, which were sent recently have been negative and the patient has had no blood in her diarrhea. Presumed cause is Augmentin, which has been stopped. The patient has continued to eat freely and is passing diarrhea despite her complaints of 10/10 severe abdominal pain. A CT scan of her abdomen was ordered, but she refused to take oral or IV contrast. The results of this CT scan are pending and will be followed up by the new medical team. | has the patient had lopressor | {
"answer_end": [
1218
],
"answer_start": [
1155
],
"text": [
"her home dose of Lopressor 25 q.i.d. and switched to Captopril,"
]
} |
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. | Is there history of use of norvasc ( amlodipine ) | {
"answer_end": [
983
],
"answer_start": [
932
],
"text": [
"NORVASC (AMLODIPINE) 10 MG PO QD HOLD IF: sbp <100,"
]
} |
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 this patient ever been prescribed nexium | {
"answer_end": [
968
],
"answer_start": [
923
],
"text": [
"The patient was also prescribed K-Dur 20 BID,"
]
} |
Glen Cooperwood, a 69 year old male with ischemic CMP (EF 25-30%), recent admission for atrial flutter, s/p ablation, and NSVT, was discharged on 6/11/05 at 12:00 PM. The patient was given ACETYLSALICYLIC ACID 81 MG PO QD, INSULIN NPH HUMAN 10 UNITS SC BID, LISINOPRIL 10 MG PO QD, OXYCODONE 5-10 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for TRICOR PO (ref #76717119), POTENTIALLY SERIOUS INTERACTION: WARFARIN & FENOFIBRATE, MICRONIZED Reason for override: monitoring INR, KEFLEX (CEPHALEXIN) 250 MG PO QID X 12 doses Starting when IV ANTIBIOTICS END, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 25 MG PO QD Food/Drug Interaction Instruction, TRICOR (FENOFIBRATE) 145 MG PO QD, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, DIET: House/Low chol/low sat. fat, ACTIVITY: No heavy lifting and do not lift L elbow above L shoulder x 1 month, Follow up appointment(s) with Dr. Vuckovich on June 10:40am, ALLERGY: NKA, ADMIT DIAGNOSIS: s/p ICD, PRINCIPAL DISCHARGE DIAGNOSIS; Responsible After Study for Causing Admission) s/p ICD, OTHER DIAGNOSIS; Conditions, Infections, Complications, affecting Treatment/Stay CHF (congestive heart failure) CAD (coronary artery disease) s/p CABG (S/P cardiac bypass graft surgery) dm (diabetes mellitus) htn (hypertension) hyperchol (elevated cholesterol) cri (chronic renal dysfunction), OPERATIONS AND PROCEDURES: none, OTHER TREATMENTS/PROCEDURES (NOT IN O.R.): s/p dual chamber ICD, BRIEF RESUME OF HOSPITAL COURSE: 69 y/o man with ischemic CMP (EF 25-30%), recent admit for atrial flutter, s/p ablation, and NSVT. Primary prevention ICD placed without complication. Had short runs of AF during procedure. For coumadin, baby ASA. Also h/o HTN, DM, CRI, CHF. ADDITIONAL COMMENTS: Continue coumadin 5mg each night. Have your INR/coumadin level checked on Monday, March, DISCHARGE CONDITION: Stable, TO DO/PLAN: No dictated summary, ENTERED BY: WEALER, ROYAL R., PA-C (NY43) 6/11/05 @ 10. | What was the dosage prescribed of coumadin | {
"answer_end": [
1812
],
"answer_start": [
1742
],
"text": [
"Continue coumadin 5mg each night. Have your INR/coumadin level checked"
]
} |
The patient is a 54-year-old man with nonischemic dilated cardiomyopathy who presents with weight gain, weakness, and azotemia. He was admitted with decompensated heart failure and was treated with dobutamine, seretide, and diuretics with good effect, functioning on ACE inhibitor. Two weeks prior to presentation, Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg t.i.d., torsemide was being held, Coumadin 1 mg q.d., carvedilol 3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage, and glyburide were administered. On 2/19/03, Diuril was added to his regimen and his creatinine was noted to increase from 2.6 to 3.6 and diuretics were subsequently held. The patient was loaded on amiodarone, unfortunately still required low dose dobutamine to maintain his cardiac output and was transferred back to the floor and continued to have decrease urine output on maximal diuretic doses and ionotropes. On 6/8/03, the renal surgery recommended that the dobutamine be stopped in order to enhance renal perfusion and Lasix be increased to 80 mg per hour. He has beyond less invasive measures such as digoxin and ACE inhibitors, and he is now dobutamine dependent dobutamine between 1 and 2.5 mcg/kg/minute to maintain his cardiac output, currently loaded on amiodarone without any further events. He has a chronic osteomyelitis, currently in a six-week course of ceftazidime, vancomycin, Flagyl, and Diflucan for complicated osteomyelitis, end date is on 2/30/03. He has diabetes and was on oral hypoglycemic as an outpatient, however, now this renal function, he has been transitioned over to insulin with his standing doses of Lantus with a lispro sliding scale. The patient was started on TPN for quite severe malnutrition and has increasing albumin with increased appetite. Additionally, he is on maintenance doses of hydrocortisone and was seen by Psychiatry, who suggested starting low dose of Zyprexa in the evening, which has greatly improved his mood. He is planned to be evaluated by Plastic Surgery prior to discharge for final plans whether a flap or healing by secondary retention. The patient currently is stable and would be discharged with home dobutamine and frequent and careful follow up by his primary cardiologist Dr. Mongiovi. | What cardiac output. meds has vet tried in past | {
"answer_end": [
784
],
"answer_start": [
734
],
"text": [
"low dose dobutamine to maintain his cardiac output"
]
} |
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic. | Has this patient ever tried aspirin | {
"answer_end": [
968
],
"answer_start": [
943
],
"text": [
"Aspirin 81 mg p.o. daily,"
]
} |
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. | Is the patient currently or have they ever taken ancef | {
"answer_end": [
728
],
"answer_start": [
680
],
"text": [
"levofloxacin and changing to Ancef 1 gm IV q.8h."
]
} |
An 81-year-old woman with Atrial Fibrillation (AF) on Fondaparinux, no Coumadin secondary to prior epistaxis, Non-small Cell Lung Cancer (NSC Lung Ca), and Pernicious Anemia (Pernicious Anemia) presents with three days of constant chest pain, pleuritic, not exertional, and mostly related to arm movement. Treatment included ACEBUTOLOL HCL 400 MG PO DAILY Starting IN AM ( 8/10 ), ALLOPURINOL 100 MG PO DAILY, VITAMIN C (ASCORBIC ACID) 500 MG PO BID, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 500 MG PO BID, CIPROFLOXACIN 250 MG PO Q12H X 4 doses (Administer iron products a minimum of 2 hours before or after a Levofloxacin or Ciprofloxacin dose dose), DIGOXIN 0.125 MG PO DAILY, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LOVENOX (ENOXAPARIN) 120 MG SC BEDTIME, TARCEVA (ERLOTINIB) 100 mg PO DAILY, FOLIC ACID 1 MG PO DAILY, FUROSEMIDE 40 MG PO DAILY Starting IN AM ( 4/9 ), DILAUDID (HYDROMORPHONE HCL) 0.5 MG PO Q4H PRN Pain (on order for DILAUDID PO, ref# 925975305, POTENTIALLY SERIOUS INTERACTION: TRAMADOL HCL & HYDROMORPHONE HCL, Reason for override: aware), LIDODERM 5% PATCH (LIDOCAINE 5% PATCH) 1 EA TP DAILY, PRAVACHOL (PRAVASTATIN) 20 MG PO BEDTIME, VITAMIN B6 (PYRIDOXINE HCL) 50 MG PO DAILY, ULTRAM (TRAMADOL) 50 MG PO Q6H PRN Pain (on order for ULTRAM PO, ref# 417339527, POTENTIALLY SERIOUS INTERACTION: MORPHINE & TRAMADOL HCL). CT-PE showed no evidence of PE or Deep Venous Thrombosis (DVT) and post Right Lower Lobe Resection changes, with interval resolution of Left Upper Lobe Nodule without new nodules, and possible chronic subsegmental PE. CXR showed no acute process. Factor Xa level was checked to insure Lovenox dosing was therapeutic. Discharge plan included mammogram next week for evaluation, continue pain control with Lidoderm patch, Ultram and low dose Dilaudid as needed for severe pain, continue Tarceva as per outpatient oncologist, continue Lovenox as outpt, continue Lasix at 40mg daily, complete course of Cipro 250mg BID x 3 days, follow up with cardiologist for continued management of heart conditions, and follow up with rehabilitation specialists to try to regain strength and function. Discharge condition was stable. | Has the patient ever tried ultram | {
"answer_end": [
1285
],
"answer_start": [
1259
],
"text": [
"ULTRAM PO, ref# 417339527,"
]
} |
Mr. Forde has recovered very well following his elective coronary artery bypass graft procedure and is hemodynamically stable with left lower extremity erythema and tenderness significantly improved 24 hours following initiation of Keflex course. White blood cell count was within normal limits and patient continued to remain afebrile. A course of Keflex was administered on postoperative day seven for sinus rhythm in the high 90s with blood pressure mildly hypertensive, additionally with frequent PVCs noted on telemetry. Mr. Notarnicola continued to remain afebrile and his knee pain has significantly improved. Additionally, of note, Mr. Hovenga's Toprol was increased to 150 mg p.o. daily with an extra 2 mg of magnesium. Mr. Neth is discharged to rehabilitation today having recovered well following his elective CABG procedure. Mr. Marcusen is discharged to rehabilitation today, postoperative day eight, hemodynamically stable, to continue a course of Keflex for left lower extremity erythema and additionally to continue one week of diuresis in the form of low dose Lasix for mild persistent postoperative pulmonary effusions. Mr. Brannigan has been instructed to shower and monitor incisions for signs of increasing infection such as fever, drainage, worsening pain or increase in redness. He is to follow up with his primary care physician for continued evaluation and management of hypertension, dyslipidemia, obesity, obstructive sleep apnea, and uncontrolled Type II diabetes mellitus. Additionally, the patient will follow up with his cardiologist for continued evaluation and management of blood pressure, heart rate, heart rhythm, lipid levels, and for possible future adjustment in medication. Mr. Connin will follow up with his cardiac surgeon, Dr. Quinn Dalio, in six to eight weeks. Additionally, he will follow up with his cardiologist, Dr. Octavio Wulffraat, in two to four weeks and with his primary care physician, Dr. Barrett Mittleman, in one to two weeks. The patient is discharged with medications including Tylenol 325 mg p.o. q.6h. p.r.n. pain for temperature greater than 101 degrees Fahrenheit, amlodipine 5 mg p.o. daily, atorvastatin 10 mg p.o. daily, captopril 6.25 mg p.o. t.i.d., Keflex 500 mg p.o. q.i.d. times total of seven days, last dose on 9/15/06, Colace 100 mg p.o. b.i.d. p.r.n. constipation, enteric-coated aspirin 325 mg p.o. daily, Lasix 40 mg p.o. daily x7 days, hydrochlorothiazide 12.5 mg p.o. daily, NovoLog 3 units subcu AC, Lantus 24 units subcu q. 10 p.m., hold if n.p.o., potassium slow release 20 mEq p.o. daily x7 days, Toprol-XL 150 mg p.o. daily, Niferex 150 mg p.o. b.i.d., oxycodone 5 to 10 mg p.o. q.4h. p.r.n. pain, Ambien 5 mg p.o. nightly p.r.n. insomnia, NovoLog 6 units subcu with breakfast, hold if n.p.o., NovoLog 4 units subcu with lunch, hold if n.p.o., NovoLog 4 units subcu with dinner, hold if n.p.o., NovoLog sliding scale subcu AC, blood sugar less than 125, give 0 units subcu, blood sugar 125 to 150, give 2 units subcu, blood sugar 151 to 200, give 3 units subcu, blood sugar 201 to 250, give 4 units subcu, blood sugar 251 to 300, give 6 units subcu, blood sugar 301 to 350, give 8 units subcu, if blood sugar 351 to 400, NovoLog sliding scale subcu q.h.s. Please recheck blood sugar less than 200, give 0 units subcu, if blood sugar 201 to 250, give 2 units subcu, blood sugar 251 to 300, give 3 units subcu, blood sugar 301 to 350, give 4 units subcu, blood sugar 351 to 400, give 10 units subcu, call physician if blood sugar greater than 400. | Why was the patient on oxycodone | {
"answer_end": [
2690
],
"answer_start": [
2626
],
"text": [
"p.o. b.i.d., oxycodone 5 to 10 mg p.o. q.4h. p.r.n. pain, Ambien"
]
} |
A 77-year-old woman presented to the ED with sudden onset of severe sharp chest pain, diaphoresis, and nausea; she was given nitro, hydralazine, SL nitro, and a nitro drip, and her pain was relieved. Cardiac catheterization showed no change from prior studies, but pulmonary hypertension was noted, and the patient was treated with heparin, ASA/Plavix (home dose), and uptitrated labetalol for BP control. A PE CT showed a pulmonary nodule, and the patient was discharged home on ACETYLSALICYLIC ACID 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 80 MG PO BEDTIME, CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY, PLAVIX (CLOPIDOGREL) 75 MG PO QAM, NEXIUM (ESOMEPRAZOLE) 20 MG PO QAM, LASIX (FUROSEMIDE) 40 MG PO QAM, INSULIN 70/30 HUMAN 40 UNITS SC BID, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, LABETALOL HCL 400 MG PO Q8H Starting Tonight (2/22), LEVOXYL (LEVOTHYROXINE SODIUM) 112 MCG PO DAILY, OXYCODONE 5-10 MG PO Q4H PRN Pain, ALDACTONE (SPIRONOLACTONE) 12.5 MG PO QAM, and DIOVAN (VALSARTAN) 160 MG PO DAILY, with instructions to take medications consistently with meals or on an empty stomach and to assess blood sugars and titrate insulin as per her doctor's instructions. She was to monitor her electrolytes with VNA in 1 week, continue diabetes teaching, and work with her VNA for aggressive diabetes management, with follow up with her outpt PCP and endocrinologist for titration of insulin and optimization of insulin regimen, as well as a pulmonary consult to evaluate for primary pulmonary disease, and a repeat chest CT in 6-12 months to follow up the pulmonary nodule. | Why did the patient have short acting...insulin | {
"answer_end": [
440
],
"answer_start": [
369
],
"text": [
"uptitrated labetalol for BP control. A PE CT showed a pulmonary nodule,"
]
} |
Ms. Elter is an 83-year-old Spanish-speaking female with history of CAD, distant three-vessel CABG, CRI, NSTEMI in 4/20 and type II diabetes who presented to the ED with PND, dyspnea on exertion, and chest heaviness with no fevers or chills and no sick contacts, and EMS had given her Lasix and Nitrospray. She was briefly on a nonrebreather mask and responded to 80 mg of IV Lasix, with her potassium level reaching 5.8 and Kayexalate administered. Her medications included aspirin, metoprolol, allopurinol, valsartan, glipizide, Lipitor, and nifedipine, with her oxygen saturation eventually reaching the high 90s on a couple of liters of oxygen and her chest x-ray full set negative. She was treated with aspirin, beta-blockers, and statin for coronary artery disease, experienced a CHF flare with an elevated BNP which was managed with Lasix and Diuril, and her after load was reduced with ARB and her previous home calcium channel blocker was weaned off. She had a transient new atrial fibrillation and ventricular ectopy which resolved spontaneously, and was placed on humidified room air with nasal saline sprays and Afrin due to her coronary artery disease. She was transfused a total of 3 units to keep her hematocrit greater than 30 and Coumadin was initially started given her new onset of atrial fibrillation, but ultimately only aspirin was given after consideration of risks versus benefits. She had some constipation which was relieved with stool softeners and the patient received a PPI. Her DM-2 was managed with regular sliding scale insulin with good blood sugar control and her glipizide was held given her worsening creatinine clearance, and her allopurinol was changed to q.72h. from q.o.d. due to the creatinine clearance and she had some left heel and foot pain thought to be secondary to gout, which improved at the time of discharge. Her hematocrit dropped from 29 to 25, her guaiac was negative on the 3/20/04, and she was sent home with VNA support to follow up on her weights and fluid status and with home physical therapy. Her medications at the time of discharge included Lasix 20 mg p.o. q.d., Lipitor 80 mg p.o. q.d., Metoprolol sustained release 100 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d. p.r.n. for constipation, Allopurinol 100 mg p.o. q.72h., Aspirin 325 mg p.o. q.d., and Valsartan 160 mg p.o. q.d. | Has a patient had valsartan | {
"answer_end": [
539
],
"answer_start": [
475
],
"text": [
"aspirin, metoprolol, allopurinol, valsartan, glipizide, Lipitor,"
]
} |
Cristopher Ottilige is a 53 year old woman with a history of diabetes mellitus who presented with abdominal pain and fevers over two weeks duration. On admission, the patient was treated with Lasix 60 mg q day, Glyburide 5 mg q day, Labetalol 200 mg b.i.d., Flagyl 500 mg p.o. q 8 hours, Levofloxacin 500 mg p.o. q 24 hours, Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day. Physical examination revealed Cervical motion tenderness and Neurologic examination found the patient alert and oriented. Abdominal CT was notable for a 7 x 8 cm low density fluid collection in the region of the right adnexa and a 4 x 8 cm low density fluid collection in the left adnexa. The patient was initially managed on triple antibiotics, ampicillin, gentamicin, and Clindamycin for empiric antimicrobial coverage, with gentamicin eventually being switched to Levofloxacin. Neurologic symptoms of abdominal pain were initially managed with Demerol and Vistaril, and by discharge the patient was without pain and afebrile. The patient was discharged on b.i.d. Flagyl 500 mg p.o. q 8 hours, Levofloxacin 500 mg p.o. q 24 hours, Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day, with instructions to call the primary care physician for fevers greater than 100.5, chills, nausea, vomiting, and abdominal pain. The patient was referred to the gynecology oncology service for further follow up as an outpatient. | Has the pt. ever been on vistaril. before | {
"answer_end": [
954
],
"answer_start": [
910
],
"text": [
"initially managed with Demerol and Vistaril,"
]
} |
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. | Is there a mention of of colace usage/prescription in the record | {
"answer_end": [
601
],
"answer_start": [
556
],
"text": [
"Colace 100 mg b.i.d., folate 1 mg p.o. daily,"
]
} |
The patient is a 60 year-old woman with adult onset diabetes mellitus, hypertension, and elevated cholesterol admitted with chest pain, bradycardia, and decreased blood pressure. When her blood pressure is elevated, she takes Nifedipine and the pain became three to four out of ten, so she took Cardizem without relief and called EMS. The pain was relieved with the EMTs gave nitroglycerin times two and they found her to have blood pressure of 190/100, heart rate 76, and normal sinus rhythm. They gave two nitrospray, blood pressure decreased to 150/80, heart rate 76, and after two minutes in the vehicle, she had sinus bradycardia at 30-40, blood pressure 120/80. She was given 0.5 mg of Atropine times one without any affect and brought to the hospital with a systolic blood pressure of 100, then suddenly she had bradycardia with heart rate of 30-40 and systolic blood pressure of 75. She was given intravenous fluids and Atropine 0.5 mg times one which increased her blood pressure systolic to 100 and her heart rate increased to 60. On admission, she was given Nifedipine 10 mg p.r.n. for elevated blood pressure, Lasix 20 mg q. day, Glucotrol 15 mg q. day, Cardizem 300 mg q. day, Coumadin 3.75 mg q. day, Colace 100 mg b.i.d., and Iron 325 mg q. day. On discharge, she was given Aspirin 325 mg q. day, Atenolol 50 mg q. day, Lisinopril 10 mg q. day, Pravachol 20 mg q. day, Glucotrol XL 15 mg q. AM, Lasix 20 mg q. day, and Nitroglycerin tablets sublingual p.r.n. chest pain. She underwent exercise tolerance test on a standard Bruce protocol and angiography which showed left main OK, LAD proximal 20%, D2 60%, ostial 90% mid, left circumflex mid 30%, OM2 distal 60-70%, OM1 mild diffuse disease. She underwent PTCA of her diagonal two which went from 90% to 0% stenosis and she received Heparin overnight and the sheaths were pulled on the following day. She is to follow-up in the VERAREA UNIVERSITY HOSPITAL Clinic with Dr. Van Rothenberg. | has there been a prior pravachol | {
"answer_end": [
1383
],
"answer_start": [
1335
],
"text": [
"Lisinopril 10 mg q. day, Pravachol 20 mg q. day,"
]
} |
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 medications has this patient tried for r elbow eczema | {
"answer_end": [
1180
],
"answer_start": [
1141
],
"text": [
"HYDROCORTISONE 1% -TOPICAL CREAM TP BID"
]
} |
Harrison Fullwood was admitted on 4/3/2005 for ICD placement for HCM. On 7/13/05, Medtronic Dual Chamber DDI/ICD was placed under general anesthesia with a CODE STATUS of Full Code and disposition of Home. ECHO 5/13 showed septal thickness 16mm, posterior wall thickness 19mm with preserved EF 65% and LV outflow tract peak gradient 125mmHg. Holter monitoring 0/2 without any arrhythmias. On admission PE, VS 96.4 74 140/90 20 93% RA. Labs/Studies included CBC, BMP, Coags wnl, EKG NSR. TW flat V5/V6 (old), CXR (portable): cardiomegaly, no e/o ptx, PA/lat CXR AM after no ptx, leads in place, no overt failure. The patient was prescribed Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid, Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily (inc to 40 or 60 during period), Kcl 20meq daily, Verapamil 120mg daily, Patanol 1-2 OU bid prn, Loratidine 10mg daily, Zocor 20mg qhs, Effexor 75mg daily, Metformin 1250mg bid, Mgoxide 500mg daily, Ambien prn, Amox prior to procedures. On order for Motrin PO (ref# 234611479), the patient had a POSSIBLE allergy to Aspirin; reaction is Unknown. The patient was instructed to take Keflex for a 3 day total course, take all medications with food, and avoid grapefruit unless MD instructs otherwise. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. ENDO: ISS. restarted Metformin on morning of d/c. NEURO: cont Effexor. On discharge, the patient was prescribed Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Wheezing, Lasix (Furosemide) 20 mg PO QD Starting Today (10/19) with instructions to titrate his dose 20mg/40mg/60mg as he normally does depending on his degree of swelling, Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache, Magnesium Oxide 560 mg PO QD, Verapamil Sustained Release 120 mg PO QD Starting Today (10/19) with instructions to confirm home dose and resume home dose, Keflex (Cephalexin) 250 mg PO QID X 10 doses, Zocor (Simvastatin) 20 mg PO QHS, Ambien (Zolpidem Tartrate) 10 mg PO QHS PRN Insomnia, Loratadine 10 mg PO QD, Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid, Metformin 1,250 mg PO BID Starting IN AM (10/19), Rhinocort Aqua (Budesonide Nasal Inhaler) 2 Spray Inh BID, Singulair (Montelukast) 10 mg PO QD, Effexor XR (Venlafaxine Extended Release) 75 mg PO QD Number of Doses Required (approximate): 5, Advair Diskus 250/50 (Fluticasone Propionate/...) 1 Puff Inh BID, Nexium (Esomeprazole) 40 mg PO QD, Oxycodone 10 mg PO Q4H PRN Pain, and Atrovent HFA Inhaler (Ipratropium Inhaler) 2 Puff Inh QID. November of 2004, HF symptoms were controlled on Lasix and at baseline he could work. The patient was also advised to take all medications with food and to avoid grapefruit unless MD instructs otherwise, and to take Keflex for a 3 day total course and to take all other medications as the same. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. | How much singulair does the patient take per day | {
"answer_end": [
769
],
"answer_start": [
693
],
"text": [
"Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily"
]
} |
This 81-year-old Italian-speaking gentleman was admitted to M Valley Medical Center with rising chest pain. Upon admission, his vital signs were normal and his physical examination was unremarkable. Cardiac catheterization revealed 30% mid RCA occlusion, 40% distal RCA, 90% ostial OM1, 90% mid CX, 80% proximal LAD, 99% mid LAD and 60% mid LM. EKG showed normal sinus rhythm and an incomplete right bundle-branch block. During his hospital stay, he was started on beta-blockers, statins, fluid resuscitation and vasopressor administration, subcu insulin, prednisone, Plavix, and antibiotics. He experienced agitation and delirium, for which he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n. Later during the hospital stay, he became hypotensive, requiring Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. He was also on Lopressor 25 orally every 6 hours, Diltiazem 125 mg orally daily, Furosemide 20 mg orally daily, Methylprednisolone 30 mg IV every 8 hours, Atorvastatin 80 mg orally daily, Allopurinol 100 mg orally daily, Ativan 0.5 mg orally at bedtime, Nexium 20 mg orally daily, and Proscar 5 mg orally every night. Tight glycemic control was maintained with Portland protocol in the immediate postop period and subsequently with subcu insulin. Incidental radiologic finding of a renal mass consistent with renal cell carcinoma was also found. Support for the patient's family was provided throughout the hospital course, and the patient was discharged with Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, Nexium 20 mg everyday, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. | Is there history of use of nexium | {
"answer_end": [
1340
],
"answer_start": [
1314
],
"text": [
"Nexium 20 mg orally daily,"
]
} |
Patient Alequin, Garland, a 57-year-old female with a complex medical history including squamous cell lung cancer, cirrhosis, COPD, HTN, PVD, seizure disorder, history of SDH, large abdominal ventral hernia, and chronic back pain, was admitted to the ED obtunded with decreased BP. She had received all her medications as prescribed in the morning at her nursing home and received Thiamine HCL 100 mg PO daily and Narcan in the ED, becoming more responsive and uncomfortable after Narcan with an elevated ammonia level of 233. To manage her mental status, the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29) and her narcotic dose was avoided. Pain was effectively controlled with MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Celecoxib 100 mg PO daily Starting Today (5/29) PRN Pain, and a Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily. She was prescribed Vitamin C (Ascorbic Acid) 500 mg PO BID, Folate (Folic Acid) 1 mg PO daily, Lasix (Furosemide) 40 mg PO daily, Flagyl (Metronidazole) 500 mg PO q8h, Aldactone (Spironolactone) 75 mg PO BID with food/drug interaction instruction to give with meals, KCL IV (ref #403310506) with serious interaction of Spironolactone & Potassium Chloride with reason for override monitoring, Thiamine HCL 100 mg PO daily, Multivitamin Therapeutic (Therapeutic Multivitamin) 1 tab PO daily, MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Flovent HFA (Fluticasone Propionate) 220 mcg INH BID, Celecoxib 100 mg PO daily, Keppra (Levetiracetam) 1,000 mg PO BID, Caltrate 600 + D (Calcium Carbonate 1,500 mg (...)), Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily, Novolog (Insulin Aspart) sliding scale (subcutaneously) SC AC with instructions to give 0-10 units subcutaneously based on BS, Maalox-Tablets Quick Dissolve/Chewable 1-2 tab PO Q6H PRN Upset Stomach, Vitamin K (Phytonadione) 5 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO daily with food/drug interaction instruction to take consistently with meals or on empty stomach, Magnesium Oxide 420 mg PO BID, Metronidazol starting on HD 1, and Vancomycin until speciation of blood cultures. Blood cultures were positive for coag negative staph in 2/4. She was also given Flovent for her known COPD and was discharged with instructions to complete a 14-day course of Cipro and Flagyl and a few changes in her medications, including MSIR every 4 hr as needed, Celebrex, and Lidoderm patch. Follow up with Dr. Vargas, Dr. Megeath, Dr. Blandin, and Dr. Pfleider as scheduled, and with PT at nursing home. Blood counts and calcium should be checked on Monday 3/21 and next week respectively. | What is her current dose of vitamin c ( ascorbic acid ) | {
"answer_end": [
942
],
"answer_start": [
883
],
"text": [
"She was prescribed Vitamin C (Ascorbic Acid) 500 mg PO BID,"
]
} |
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 ever had prozac | {
"answer_end": [
2004
],
"answer_start": [
1981
],
"text": [
"Prozac 20 mg p.o. q.d.,"
]
} |
Ms. Loften is a 62 year old woman with cardiac risk factors including hypertension, diabetes mellitus, postmenopause, and exertional angina for four months. On admission, her medications included Aspirin q.d., Enalapril 20 mg b.i.d., Cardizem 300 mg q.d., Insulin mixed 70/30 with 60 units in the morning and 30 in the evening, and Atenolol 50 mg q.d., with an additional Simvastatin 10 mg q.h.s. She had a history of Penicillin allergy which gave her edema, and a deep venous thrombosis in 1994, chronic renal insufficiency, cholecystectomy and vitiligo. Her family history is significant for brothers who had myocardial infarctions in their 50's and 60's, and a mother who had a myocardial infarction when she was 69. She was admitted for premedication overnight prior to catheterization due to a previous allergic reaction to contrast dye that caused laryngeal edema. On examination, her chest pain radiates to her left arm, is associated with shortness of breath, but no diaphoresis or nausea or vomiting, and is relieved by rest within two minutes or by a sublingual Nitroglycerin, which she has used in the past week x two. The patient underwent successful balloon angioplasty of the mid left anterior descending artery stenosis from 70 percent to 10 percent and had a mild occurrence of chest pain post catheterization which was relieved with two sublinguals, and showed no electrocardiogram changes. On discharge, she was prescribed Aspirin 325 mg q.d., Enalapril 20 mg b.i.d., Cardizem 300 mg q.d., Insulin mixed 70/30 with 60 units in the morning and 30 in the evening, Atenolol 50 mg q.d., and Simvastatin 10 mg q.h.s. She was discharged in stable condition with an appointment the day after discharge with Dr. Mondone. | How much aspirin does the patient take per day | {
"answer_end": [
1461
],
"answer_start": [
1422
],
"text": [
"she was prescribed Aspirin 325 mg q.d.,"
]
} |
A 43 year old female with metastatic tall cell papillary cancer to bilateral IJ nodes, who had undergone RAI, left paratracheal and modified radial neck dissection, and a total thyroidectomy in 1/24, was admitted to the hospital. During her hospital stay, she was started on ROCALTROL (CALCITRIOL) 0.5 MCG PO BID, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 1,000 MG PO Q6H, HYDROCHLOROTHIAZIDE 25 MG PO DAILY, SYNTHROID (LEVOTHYROXINE SODIUM) 200 MCG PO BID, and OXYCODONE 5-10 MG PO Q4H PRN Pain. ATENOLOL 100 MG PO DAILY was started the following day. Her diet was advanced and pain was well controlled on oral medications. She required multiple doses of IV medication (labetalol and hydralazine) to control her hypertension on pod#0. Her serum calcium levels were 7.5 and 8.1 on recheck, and she was neurologically intact, af, hd stable and wound was c/d/i. She was discharged to follow up with Dr. Macky and her primary care provider. Medications instructed were: erythromycin leads to GI upset, 500mg elemental calcium is the equivalent of 1250mg of calcium carbonate, and typical dose of Synthroid is 1 mcg per pound. She was also instructed to not immerse wound in bath, swimming or sauna for two weeks, not to drive while taking narcotics, and to follow up with primary care provider concerning hospitalization. | Has the patient ever been on atenolol | {
"answer_end": [
521
],
"answer_start": [
497
],
"text": [
"ATENOLOL 100 MG PO DAILY"
]
} |
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 nph insulin prescriptions | {
"answer_end": [
723
],
"answer_start": [
656
],
"text": [
"His current medications include NPH Insulin 32 units every morning,"
]
} |
This is a 61-year-old gentleman with severe pulmonary hypertension secondary to chronic PEs, OSA, gout, bilateral hip replacements who presents with two falls in the past two days. He was compliant with his medication regimen and denies dietary indiscretion. He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5, initially being supertherapeutic with a daily goal of negative 500 to 1 L with IV Lasix once or twice a day as needed, his home dose being 160 mg p.o. His baseline room air oxygen saturation was 90-93% and he should use oxygen as treatment for his pulmonary hypertension and be provided with oxygen at home. He was treated for his hip pain initially with oxycodone which was changed to Dilaudid for better pain control, and he should be changed back to his home dose of oxycodone when discharged. He also has a history of gout which was exacerbated with diuresis and he is on his home doses of allopurinol and colchicine, Indocin being added and he should receive a total of three days of Indocin. Tylenol and narcotics as previously described can be used to help with his gouty pain. His GI regimen includes Nexium at home and Prilosec while an inpatient, and he should be switched back to Nexium when discharged from rehabilitation. His lab results on discharge include a creatinine of 1, hematocrit of 53.1 and INR of 2.3, potassium being 3.9 and magnesium being 2.0. The discharge medications include Coumadin 11 mg on Monday, Wednesday and Friday and 12 mg the other days of the week, Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day, hydrochlorothiazide 25 once a day, Lasix 160 IV once per day, allopurinol 200 once per day, colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain, Tylenol 500-1000 mg p.o. q.6 h. p.r.n. pain not to exceed 4 gm total from all sources in a 24-hour period, Ambien 10 mg p.o. nightly p.r.n. insomnia. He is being discharged to rehab with a followup with his cardiologist, Dr. Insco, and an appointment with Endocrinology. | Is there a mention of of colace usage/prescription in the record | {
"answer_end": [
1864
],
"answer_start": [
1765
],
"text": [
"colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain,"
]
} |
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. | Was the patient ever given medication for tia | {
"answer_end": [
731
],
"answer_start": [
664
],
"text": [
"Neuro: recent history of TIA, on Coumadin, may not want to reverse."
]
} |
This 81-year-old Italian-speaking gentleman was admitted to M Valley Medical Center with rising chest pain. Upon admission, his vital signs were normal and his physical examination was unremarkable. Cardiac catheterization revealed 30% mid RCA occlusion, 40% distal RCA, 90% ostial OM1, 90% mid CX, 80% proximal LAD, 99% mid LAD and 60% mid LM. EKG showed normal sinus rhythm and an incomplete right bundle-branch block. During his hospital stay, he was started on beta-blockers, statins, fluid resuscitation and vasopressor administration, subcu insulin, prednisone, Plavix, and antibiotics. He experienced agitation and delirium, for which he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n. Later during the hospital stay, he became hypotensive, requiring Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. He was also on Lopressor 25 orally every 6 hours, Diltiazem 125 mg orally daily, Furosemide 20 mg orally daily, Methylprednisolone 30 mg IV every 8 hours, Atorvastatin 80 mg orally daily, Allopurinol 100 mg orally daily, Ativan 0.5 mg orally at bedtime, Nexium 20 mg orally daily, and Proscar 5 mg orally every night. Tight glycemic control was maintained with Portland protocol in the immediate postop period and subsequently with subcu insulin. Incidental radiologic finding of a renal mass consistent with renal cell carcinoma was also found. Support for the patient's family was provided throughout the hospital course, and the patient was discharged with Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, Nexium 20 mg everyday, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. | What medications has this patient tried for agitation. | {
"answer_end": [
959
],
"answer_start": [
890
],
"text": [
"Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation,"
]
} |
Mr. Notari was admitted to the Orthopaedic Hand Service on 1/18/2006 with a history of increased right shoulder pain following a cellulitis of the right hand. An ESR was checked on admission and was slightly elevated at 18. He was afebrile and non-toxic, therefore was not started on antibiotics. Dilaudid was added to his pain regimen for his increased discomfort. On 9/25/2006 a CT guided right shoulder joint fluid aspiration was performed by Radiology. Analysis of this fluid was not consistent with joint infection. He received Lovenox for DVT prophylaxis during his admission. On HD#4 he was awake, alert, appropriate and afebrile with stable vital signs. His pain was well controlled on oral medications. He was discharged to home with a prescription for COLACE (DOCUSATE SODIUM) 100 MG PO BID, NEXIUM (ESOMEPRAZOLE) 40 MG PO BID, DILAUDID (HYDROMORPHONE HCL) 2-6 MG PO Q4H PRN Pain, ATROVENT HFA INHALER (IPRATROPIUM INHALER) 2 PUFF INH QID PRN Shortness of Breath, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO BID, MS CONTIN (MORPHINE CONTROLLED RELEASE) 45 MG PO QAM, MS CONTIN (MORPHINE CONTROLLED RELEASE) 30 MG PO QPM, SIMVASTATIN 80 MG PO DAILY, TERAZOSIN HCL 10 MG PO DAILY, and Number of Doses Required (approximate): 3, with instructions to do pendulum range of motion exercises regularly, not to drive a motor vehicle, drink any alcohol or operate machinery while taking the medication, drink plenty of water and take a stool softener (Colace) to help prevent constipation, not to drive a car until cleared to do so by a doctor, and to resume home medications unless specifically instructed otherwise. He was also advised to call a doctor or go to a local emergency room if he developed any concerning symptoms. His final joint fluid cultures were pending at the time of discharge, he will be contacted at home if these turn positive. | Has the patient ever had nexium ( esomeprazole ) | {
"answer_end": [
837
],
"answer_start": [
802
],
"text": [
"NEXIUM (ESOMEPRAZOLE) 40 MG PO BID,"
]
} |
The patient, Jacob M. Pobre, was admitted on 1/18/2005 for PPM placement. Discharge was on 1/7/2005. The code status was Full Code and disposition was Home. The patient was discharged on 7/7/05 at 01:00 PM contingent upon attending evaluation. The discharge medications included ECASA (Aspirin Enteric Coated) 325 MG PO QD, ZESTRIL (Lisinopril) 2.5 MG PO QD, ZOLOFT (Sertraline) 50 MG PO QD, KEFLEX (Cephalexin) 250 MG PO QID X 12 doses starting when IV antibiotics end, ARICEPT (Donepezil HCL) 10 MG PO QPM with number of doses required (approximate) 1, PLAVIX (Clopidogrel) 75 MG PO QD, TOPROL XL (Metoprolol (Sust. Rel.)) 50 MG PO QD, LIPITOR (Atorvastatin) 80 MG PO QD, GLUCOPHAGE (Metformin) 500 MG PO QD, GLYBURIDE 1.25 MG PO QD, diet of house/low chol/low sat. fat, 2 gram sodium, and activity of walking as tolerated. The admit diagnosis was CHB and the principal discharge diagnosis was PPM placement. The patient had 3VD, DM, HTN, CAD, and CRI. PPM was placed on 0/7/05 without complications and no other treatments/procedures were done. The patient was stable at discharge and was to follow up as arranged by cardiology. | has there been a prior glucophage ( metformin ) | {
"answer_end": [
710
],
"answer_start": [
674
],
"text": [
"GLUCOPHAGE (Metformin) 500 MG PO QD,"
]
} |
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 taken any medications for pain management | {
"answer_end": [
509
],
"answer_start": [
431
],
"text": [
"Her pain was only controlled with oxycodone and she was pain-free at discharge"
]
} |
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. | Has a patient had lisinopril | {
"answer_end": [
812
],
"answer_start": [
789
],
"text": [
"Lisinopril 30 mg PO QD,"
]
} |
This 81-year-old Italian-speaking gentleman was admitted to M Valley Medical Center with rising chest pain. Upon admission, his vital signs were normal and his physical examination was unremarkable. Cardiac catheterization revealed 30% mid RCA occlusion, 40% distal RCA, 90% ostial OM1, 90% mid CX, 80% proximal LAD, 99% mid LAD and 60% mid LM. EKG showed normal sinus rhythm and an incomplete right bundle-branch block. During his hospital stay, he was started on beta-blockers, statins, fluid resuscitation and vasopressor administration, subcu insulin, prednisone, Plavix, and antibiotics. He experienced agitation and delirium, for which he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n. Later during the hospital stay, he became hypotensive, requiring Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. He was also on Lopressor 25 orally every 6 hours, Diltiazem 125 mg orally daily, Furosemide 20 mg orally daily, Methylprednisolone 30 mg IV every 8 hours, Atorvastatin 80 mg orally daily, Allopurinol 100 mg orally daily, Ativan 0.5 mg orally at bedtime, Nexium 20 mg orally daily, and Proscar 5 mg orally every night. Tight glycemic control was maintained with Portland protocol in the immediate postop period and subsequently with subcu insulin. Incidental radiologic finding of a renal mass consistent with renal cell carcinoma was also found. Support for the patient's family was provided throughout the hospital course, and the patient was discharged with Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, Nexium 20 mg everyday, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. | Was the patient ever prescribed atorvastatin | {
"answer_end": [
1247
],
"answer_start": [
1215
],
"text": [
"Atorvastatin 80 mg orally daily,"
]
} |
A 63 year old male with a history of diabetes mellitus (DM), hypertension (HTN), obesity, and hyperlipidemia presented with chest pain two days ago and a four week history of chronic productive cough, rhinorrhea, and a sensation of nasal discharge down the back of the throat. Labs showed a normal chemical seven, CBC, and cardiac enzymes, and a CXR showed no acute process. The patient was started on ASA and a statin, Lipitor (Atorvastatin) 40 mg PO daily, ECASA 325 mg PO daily, Lantus (Insulin Glargine) 100 units SC daily, Humalog Insulin (Insulin Lispro) 12 units SC AC, Combivent (Ipratropium and Albuterol Sulfate) 2 spray NA daily, Loratadine 10 mg PO daily starting today (5/25), Metformin 1,000 mg PO BID, Prilosec (Omeprazole) 20 mg PO daily, and Azithromycin 250 mg PO daily x 3 doses. Potentially serious interactions were noted for Azithromycin and Atorvastatin Calcium, Simvastatin and Azithromycin, and Valsartan and Potassium Chloride, and the patient was instructed to follow up with his PCP for a possible outpatient stress imaging. In addition, the patient was prescribed Flonase Nasal Spray (Fluticasone Nasal Spray) 2 spray NA daily, Diovan (Valsartan) 160 mg PO daily, and provided with inhalers for wheezing PRN, with diet prophy: lovenox, nexium, 2 gram sodium, house/low chol/low sat. fat, and house/ADA 2100 cals/dy. An override was added on 8/15/06 by NAUMANN, CLAIR L., M.D. on order for Potassium Chloride Immed. Rel. PO (ref # 845941861). The patient was discharged with instructions to follow up with his PCP for a possible outpatient stress imaging and to take his medications as directed. | has the patient used ecasa in the past | {
"answer_end": [
481
],
"answer_start": [
459
],
"text": [
"ECASA 325 mg PO daily,"
]
} |
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. | Why is the patient on gentle hydration therapy | {
"answer_end": [
1259
],
"answer_start": [
1194
],
"text": [
"He was given gentle hydration therapy with 2 liters of IV fluids,"
]
} |
Mrs. Wetterauer is a 54-year-old female with coronary artery disease status post inferior myocardial infarction in March of 1997, with sick sinus syndrome, status post permanent pacemaker placement, and paroxysmal atrial fibrillation controlled with amiodarone; also with history of diabetes mellitus and hypertension. On 1/11, she experienced severe respiratory distress and was unable to be intubated on the field. She was ultimately intubated at Sirose, and an echocardiogram showed an ejection fraction of 25 to 30 percent with flat CKs. She was diuresed six liters and a right heart catheterization showed a pulmonary artery pressure of 40/15, wedge of 12, and cardiac output of 5.2. Hemodynamics indicated her cardiac output was dependent on her SVR. At the outside hospital, a right upper lobe infiltrate was noted and she was given gentamicin 250 mg times one, and clindamycin 600 mg. She was diagnosed with pneumonia and treated with clindamycin, which caused resolution of her white count. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. Her last admission was on 10/6 for atypical chest pain, and she was placed on Bactrim Double Strength b.i.d. times a total of seven days, as well as Lovenox 60 mg b.i.d., aspirin 325 p.o. q.d., lisinopril 40 mg p.o. b.i.d., digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. Home medications include amiodarone 200 mg p.o. q.d., Glyburide 5 mg p.o. q.d., Lopressor 50 mg p.o. b.i.d., Prempro 0.625/2.5 p.o. q.d., lisinopril 40 mg p.o. q.d., Coumadin, nitroglycerin sublingual, Zantac, beclomethasone, and Ventolin. Medications on transfer, Lovenox 60 mg b.i.d., aspirin 325 p.o. q.8, digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. The patient was also placed on Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Glyburide 5 mg p.o. q.d., Lasix 20 mg p.o. q.d., atenolol 150 mg p.o. q.d., diltiazem CD 240 mg p.o. q.d., and resolved with 20 mg of Lasix p.o. q.d. Mrs. Wetterauer was admitted to the Aley Coness-o Meoak Medical Center for paroxysmal atrial fibrillation controlled with amiodarone, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma. For her anxiety, the patient was treated acutely with Ativan and her problem resolved quite well, and she became more comfortable in the hospital. Diabetes Mellitus was managed with Glyburide held initially on admission, covered with insulin sliding scale, and restarted on discharge. Edema was managed with Lasix 20 mg p.o. q.d. and resolved with 20 mg of Lasix p.o. q.d. Urinary Tract Infection was managed with antibiotics. She was discharged with medications including amiodarone 200 mg p.o. q.d., lisinopril 40 mg p.o. b.i.d., Tapazole 10 mg | has the patient had lasix | {
"answer_end": [
2265
],
"answer_start": [
2243
],
"text": [
"Lasix 20 mg p.o. q.d.,"
]
} |
This is a 62 year old rug salesman who was first diagnosed with exertional chest pain and hospitalized for a strongly positive stress test in 1981. Recently he noticed increasing angina with chest aching, throat aching, and dryness of the throat. On January, 1991 he had an exercise treadmill test which was stopped due to 1 mm ST depression in Leads II, III, F and V4 to V6. He experienced chest discomfort and noticed more frequent anginal pain with throat, chest, and chest pressure in both arms while playing golf. On the day of admission he noticed some pain at work while moving around the office. Medications on admission were LoPressor 50 mg p.o. b.i.d., Isordil 20 mg p.o. t.i.d., Verapamil 80 mg p.o. t.i.d., Xanax 0.25 mg p.o. b.i.d. p.r.n., one aspirin q.d. and p.r.n. nitroglycerin. A percutaneous transluminal coronary angioplasty was performed in which a proximal circumflex was dilated from 95% to 20%, with the only other lesion being a right coronary artery of 30%. He was discharged home in excellent condition on LoPressor 50 mg p.o. b.i.d., Isordil 20 mg p.o. t.i.d., Verapamil 80 mg p.o. t.i.d., one aspirin q.d. and Pepcid 20 mg p.o. b.i.d. | How often does the patient take isordil | {
"answer_end": [
752
],
"answer_start": [
690
],
"text": [
"Verapamil 80 mg p.o. t.i.d., Xanax 0.25 mg p.o. b.i.d. p.r.n.,"
]
} |
A 57-year-old female with macromastia and abdominal skin laxity s/p massive weight loss 2/2 gastric bypass was admitted to plastic surgery on 5/8/07. On admission, the patient was prescribed 1. ACETAMINOPHEN 1000 MG PO Q6H, 2. LEVOTHYROXINE SODIUM 75 MCG PO QD, 3. QUINAPRIL 20 MG PO QAM, 4. RANITIDINE HCL 150 MG PO QD, 5. MULTIVITAMINS 1 CAPSULE PO QD, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, VITAMIN C ( ASCORBIC ACID ) 500 MG PO BID, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, KEFLEX ( CEPHALEXIN ) 500 MG PO QID, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, PEPCID ( FAMOTIDINE ) 20 MG PO BID, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain (ref #901341233), on order for DILAUDID PO 2-4 MG Q3H (ref #901341233), INSULIN REGULAR HUMAN, supplemental (sliding scale) insulin, If receiving standing regular insulin, please give at same, SYNTHROID ( LEVOTHYROXINE SODIUM ) 75 MCG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ), REGLAN ( METOCLOPRAMIDE HCL ) 10 MG IV Q6H PRN Nausea, ZOFRAN ( POST-OP N/V ) ( ONDANSETRON HCL ( POST-... ), on order for KCL IV (ref #964491549), POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM, SIMETHICONE 80 MG PO QID PRN Upset Stomach, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, TIGAN ( TRIMETHOBENZAMIDE HCL ) 200 MG PR Q6H PRN Nausea, ibuprfen. Do not drink/drive/operate machinery with pain medications., Take a stool softener to prevent constipation., 4. Continue your antibiotics as long as you have a drain in place., Sliding Scale (subcutaneously) SC AC+HS Medium Scale, If BS is 125-150, then give 0 units subcutaneously, 30 MILLILITERS PO DAILY PRN Constipation, 1 MG IV Q6H X 2 doses PRN Nausea, Number of Doses Required (approximate): 10, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain. The patient tolerated all procedures without difficulty and post-op period was uneventful, and at discharge, the patient was afebrile with stable vitals, taking po's/voiding q shift, ambulating independently and pain was well-managed with Tigan (Trimethobenzamide HCl) 200 mg PR Q6H PRN Nausea, Tigan (Trimethobenzamide HCl) 300 mg PO Q6H PRN Nausea, Simethicone 80 mg PO QID PRN Upset Stomach, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, 1 mg IV Q6H x 2 doses PRN Nausea, 30 Milliliters PO Daily PRN Constipation and TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, DULCOLAX (Bisacody | Has the patient had multiple multivitamins prescriptions | {
"answer_end": [
354
],
"answer_start": [
324
],
"text": [
"MULTIVITAMINS 1 CAPSULE PO QD,"
]
} |
The 65-year-old female patient with a history of hypertension, hypercholesterolemia, non-insulin-dependent diabetes mellitus, and no known hx of CAD was admitted with chest pain. On November 1997, an exercise treadmill test revealed a maximal heart rate of 127 and maximal blood pressure of 134/80, with 1 millimeter of ST depression in V5 and T-wave inversions in V4-V6, consistent with, but not diagnostic ischemia. She had a history of sarcoidosis, seizure disorder, pacemaker placement, appendectomy, total abdominal hysterectomy for cervical cancer, adult onset diabetes mellitus, and left calf deep vein thrombosis in 1993. Medications at the time of admission included Linsinopril 5 mg q.d., Pravachol 20 mg q.h.s., aspirin 325 mg q. day, atenolol 0.5 mg b.i.d., Dilantin 200 mg b.i.d., Ventolin inhaler p.r.n., and ferrous gluconate 325 mg t.i.d. Hematocrit on June 1997 was noted to be 29.3 and the patient had been on iron supplements since then. On admission, she was given Nitrol paste and, for her ischemia, she was transfused with one unit of packed red cells. Diagnostic ischemia was present, and she was started on aspirin and atenolol. In the past, she has been treated with prednisone and black secondary to iron supplementation. Two cardiac catheterizations were performed, which showed a 70% residual osteal diagonal stenosis and 0% left anterior descending stenosis. A stent was placed in the diagonal artery with 0% residual stenosis and her left anterior descending was stented. At the time of discharge her medications included Ticlid 250 mg p.o. b.i.d., albuterol inhaler 2 puffs q.i.d. as needed for shortness of breath, enteric-coated aspirin 325 mg p.o. q.d., atenolol 37.5 mg p.o. b.i.d., nitroglycerin 1/150 sublingual one tablet q. 5 minutes times three for chest pain, and Dilantin 200 mg p.o. b.i.d. She was also taking linsinopril 5 mg q.d., Pravachol 20 mg q.h.s., ferrous gluconate 325 mg t.i.d., and Ventolin inhaler p.r.n. She is scheduled to followup with Dr. Doug Millis in her office in one week and will follow up with cardiology as an outpatient. | Has this patient ever been treated with ticlid | {
"answer_end": [
1578
],
"answer_start": [
1552
],
"text": [
"Ticlid 250 mg p.o. b.i.d.,"
]
} |
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06. | Has the patient had previous furosemide | {
"answer_end": [
1086
],
"answer_start": [
1028
],
"text": [
"was thus placed on a nitroglycerin drip, a furosemide drip"
]
} |
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 | How often does the patient take lisinopril | {
"answer_end": [
2105
],
"answer_start": [
2061
],
"text": [
"LISINOPRIL 20 MG PO DAILY HOLD IF: SBP <110,"
]
} |
Mr. Esbenshade is a 70-year-old Caucasian male with CAD, stented five years ago, known as calcific aortic stenosis with progression of exertional dyspnea. He was admitted to CSS and stabilized for surgery on 9/13/06, which included AVR with a 25 CE magna valve, CABG x2 with LIMA to LAD and SVG1 to PDA, pulmonary vein isolation, and left atrial appendage resection, with no complications. He is currently on 5 liters of O2 and some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis, on Osmolite tube feeds at 20 mL an hour, with prophylactic antibiotics for chest tubes, medications IV, Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily, atorvastatin 20 mg daily, Neurontin 100 mg t.i.d., metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d. Cardiac meds include Aspirin, Lopressor, and Coumadin. He has been followed by psych for postoperative confusion/possible suicidal ideation, with Celexa ordered per psych. He is also on Acetaminophen 325-650 mg q. 4h. p.r.n. pain or temperature greater than 101, DuoNeb q. 6h. p.r.n. wheezing, enteric-coated aspirin 81 mg daily, Dulcolax 10 mg PR daily p.r.n. constipation, Celexa 10 mg daily, Colace 100 mg t.i.d., Nexium 20 mg daily, K-Dur 10 mEq daily for five days, Toprol-XL 200 mg b.i.d., miconazole nitrate powder topical b.i.d., Niferex 150 mg b.i.d., simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily, INR, and Boudreaux's Butt Paste topical apply to effected areas. He has been running a bit fast in Afib and is on Coumadin and aspirin for atrial fibrillation, and is awaiting a rehabilitation bed. Cipro x3 days has been started due to a UA from 10/5/06 with probable enterogram-negative rods. His mood has improved and beta-blocker has been titrated. He has been advised to make all follow-up appointments, local wound care, wash wounds daily with soap and water, shower patient daily, keep legs elevated while sitting/in bed, watch all wounds for signs of infection, redness, swelling, fever, pain, discharge, and to call PCP/cardiologist or Anle Health Cardiac Surgery Service at 282-008-4347 with any questions. | has there been a prior neurontin | {
"answer_end": [
722
],
"answer_start": [
672
],
"text": [
"atorvastatin 20 mg daily, Neurontin 100 mg t.i.d.,"
]
} |
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs. | has the patient used nexium in the past | {
"answer_end": [
1912
],
"answer_start": [
1845
],
"text": [
"His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d.,"
]
} |
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40---> | Has this patient ever been on lasix ( furosemide ) | {
"answer_end": [
440
],
"answer_start": [
376
],
"text": [
"Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain,"
]
} |
Ms. Hesby is a 36-year-old woman with very poorly controlled type 1 diabetes, end-stage renal disease, right eye blindness, lower extremity neuropathy, gastroparesis, and a history of extensive infections. She presented to Path Community Hospital with a right thigh burn and infection, and was given a prescription for antibiotics, 20 units of IV insulin, 500 mL normal saline boluses, and several 250 mL boluses, as well as 2 amps of calcium gluconate, Kayexalate, albuterol nebs, and Augmentin and IV vancomycin for her right thigh cellulitis. For long-term management, she was prescribed Lantus 24 units subcu each night, NovoLog sliding scale, PhosLo, Nephrocaps, Vitamin D, Sevelamer 1600 t.i.d., Toprol 100 mg p.o. daily, Lisinopril 5 mg p.o. daily, Plavix 75 mg p.o. daily, Keppra 500 mg p.o. b.i.d., Flovent two puffs b.i.d., Albuterol p.r.n., Baclofen 5 mg p.o. t.i.d., and Ambien 10 mg p.o. at bedtime p.r.n. The patient was admitted with a diagnosis of Diabetic Ketoacidosis (DKA) and was stabilized in the MICU on an insulin waves. She was then transitioned to NPH and finally to Lantus 24 units subcu and her hypertension is being managed on her home dose of Lopressor 25 q.i.d. and switched to Captopril, which is being titrated. Her area of cellulitis has completely resolved, and if she becomes acidotic, the patient can be managed with sodium bicarbonate and D5W in small boluses. The patient is taking her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d., however she has consistently refused her heparin. Of note, on the night of 1/26/06, the patient complained of severe cramping, right lower quadrant pain, which is new. She noted this pain has increased rapidly in the setting of diarrhea. Several C. diff studies, which were sent recently have been negative and the patient has had no blood in her diarrhea. Presumed cause is Augmentin, which has been stopped. The patient has continued to eat freely and is passing diarrhea despite her complaints of 10/10 severe abdominal pain. A CT scan of her abdomen was ordered, but she refused to take oral or IV contrast. The results of this CT scan are pending and will be followed up by the new medical team. | Was the patient ever prescribed lantus | {
"answer_end": [
624
],
"answer_start": [
591
],
"text": [
"Lantus 24 units subcu each night,"
]
} |
This is a 69 year-old woman with a history of congestive heart failure and hypertension who presented with a productive cough which was worsening over the past 3-4 days and fever to 101 with chills and shakes and increasing shortness of breath. She had a white blood cell count of 9.3 with 54% polys and 9.6 % eosinophils, a glucose of 377, and a chest x-ray without evidence of congestive heart failure or infiltrate. She was treated in the emergency room with Albuterol nebulizer and plans were to discharge her to home, however, her saturations dropped to 89% on room air with exercise in the emergency room and was admitted for further observation. She was started on intravenous Cefuroxime, and initially improved with decrease in cough and shortness of breath; however, the patient continued to desat with exercise. A repeat chest x-ray was performed which showed no change when compared to the admission film. Her sputum culture grew out Pen-sensitive E-coli and she was continued on her intravenous and then PO antibiotics. She continued to desat with exercise, however, and her cough persisted although she remained afebrile with a slightly elevated white count and moderate peripheral eosinophilia. Her chest exam remained rancorous and the reason for this remained unclear. Given the finding of E-coli in the sputum sample, in addition to the elevated eosinophilia and lack of finding on chest x-ray despite significant findings on chest exam, the possibility of a worm or parasitic disease was raised. She had a Persantine MIBI in March of 1996, on which she had no fixed or reversible defects, and was on nitroglycerin for stable angina - "chest heaviness" after climbing one flight of stairs, relieved by rest and one sublingual nitroglycerin. Her medications on admission included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m. and 5 units q p.m., Verapamil SR 120 mg PO b.i.d., Enteric coated aspirin 325 mg q day, KCL 10 mEq PO q day, Premarin 0.625 mg PO q day, Zestril 20 mg b.i.d., Atenolol, recently discontinued, Tofranil 75 mg PO q HS, Albuterol inhaler two puffs inhaled q.i.d., and Potassium slow release 10 mEq PO q day. She was discharged to home with Albuterol inhaler and instructions to follow up with her primary physician in clinic for further evaluation including PFTs and possible chest CT if symptoms did not abate, and to finish a full ten day course of antibiotics for presumed bronchitis. At the time of discharge the patient's saturation was 92 to 93% on room air and dropping slightly to 90 to 91% with exercise, however she was tolerating this well and was getting relief from her Albuterol inhaler. | What was the dosage prescribed of lasix | {
"answer_end": [
1847
],
"answer_start": [
1787
],
"text": [
"included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m."
]
} |
Mr. Lumadue is a 68-year-old man with significant cardiac history and vascular disease who came in with a chief complaint of hip pain after a mechanical fall. At that time, his hospital course was complicated by a non-Q wave MI, and Cardiology recommended medical management with Lopressor. An echocardiogram revealed an ejection fraction of 45%, and Dobutamine MIBI revealed a severe fixed perfusion defect in the inferoposterior and inferoseptal left ventricle with an ejection fraction of 26%. His medications included HCTZ 50 mg PO q.d., enteric-coated aspirin 325 mg PO q.d., Zestril 20 mg PO q.d., glyburide 5 mg PO q.d., multivitamins, and cough medicine PRN. Upon admission, his vital signs were afebrile, temperature 97.3, tachycardia, heart rate 106, blood pressure 162/77, oxygenation 94% on room air. X-rays of his left pelvis and femur revealed fracture of the left intertrochanter and subtrochanteric fracture with lesser trochanteric fracture intact by 3 cm, less than five degrees angulation. His femoral head was reduced. During his hospital course, the patient was started on a beta blocker, Ace inhibitor, and continued on an aspirin. He was aggressively diuresed with Lasix for diuresis and was treated with vancomycin, Flagyl, and levofloxacin for presumed aspiration pneumonia. He was continued on Lovenox 60 mg subcu. b.i.d. for prophylaxis against DVT post-hip surgery to continue for six months minimal followed by orthopedic surgery, and restarted on oral hypoglycemics prior to discharge in addition to sliding scale insulin. He was discharged on standing 20 mEq of K-Dur q.d., lisinopril 5 mg PO q.d., hold for systolic blood pressure less than 100, Lasix 100 mg PO q.d., Lovenox 60 mg subcu. b.i.d. x6 months, glipizide 2.5 mg PO q.d., sliding scale insulin, Nexium 20 mg PO q.d., Silvadene wet-to-dry dressing, DuoDerm to left lower leg wound and change q.3 days, and Lopressor 12.5 mg PO t.i.d., hold for systolic blood pressure less than 100. He was maintained on Nexium prophylaxis in the setting of his anticoagulation and on two liters of nasal cannula oxygen at the time of transfer to rehab. Upon discharge, he was instructed to follow up with his primary care physician, orthopedic surgery, cardiology, and pulmonary medicine within two weeks, with labs for a metabolic panel, magnesium, and calcium q.o.d. and physical therapy as needed, with a weightbearing status of non-weightbearing on the left lower extremity and weightbearing as tolerated on the right lower extremity. | Why is the patient prescribed beta blocker | {
"answer_end": [
1153
],
"answer_start": [
1079
],
"text": [
"was started on a beta blocker, Ace inhibitor, and continued on an aspirin."
]
} |
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 there been a prior ecasa ( aspirin enteric coated ) | {
"answer_end": [
260
],
"answer_start": [
216
],
"text": [
"ECASA (Aspirin Enteric Coated) 325 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. | What medications if any has the patient tried for her uti in the past | {
"answer_end": [
1271
],
"answer_start": [
1189
],
"text": [
"Foley was placed for comfort with catheter in place. While on Bactrim for her UTI,"
]
} |
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 | Is the patient currently or have they ever taken medications | {
"answer_end": [
946
],
"answer_start": [
887
],
"text": [
"CXR, diuresis with IV medications, EKG, R/O MI, and Abdo CT"
]
} |
Mr. Gramby is a 43-year-old man with morbid obesity, type II diabetes, hypertension, hyperlipidemia, chronic renal insufficiency, and severe peripheral arterial disease status post femoral popliteal bypass in July which was complicated by repeated return of cellulitis x 2 who was admitted with cellulitis and volume overload. He was initially treated with courses of intravenous nafcillin and vancomycin for four weeks, having been seen by Vascular Surgery five days prior to admission and had been started on dicloxacillin for a third episode of cellulitis. He had also presented with fluid overload and spironolactone was added to his diuretic regimen. The patient was prescribed Atenolol 100 mg q.d., spironolactone, torsemide 160 mg b.i.d., Hyzaar 50/12.5 q. day, lisinopril 60 mg q. day, Neurontin 1200 mg t.i.d., Norvasc 10 mg q.a.m. and 5 mg q.p.m., Coumadin 8 mg, aspirin, Humalog sliding scale, Percocet, Pletal 100 mg b.i.d., Procrit, Zantac, nitroglycerin p.r.n., and NPH 80 q.a.m. and q.p.m. His torsemide was changed to IV and metolazone was added on the first day of admission and his electrolytes were replaced as needed. He was hypertensive on arrival, which was treated with Hydralazine initially and transitioned to his p.o. home medicines, with Hydralazine p.o. added on hospital day #9 to lower his systolic blood pressure to the range of the 120s-130s. His Coumadin was restarted when his INR was 2.2 and he his now in the therapeutic range and will need to be followed. The patient is on NPH and Humalog, with NPH doses increased to 90 units in the morning and 85 units at night, and the goal for this patient is below 150 particularly given the need for wound healing. Additional antibiotic coverage was added specifically of fluoroquinolone for anti-psuedomonal coverage for his diabetic foot ulcers, with surgical debridement done in the operating room with drainage of pus, but the metal showed could not be located even with fluoroscopy. The patient will complete a 14-day course of levofloxacin and clindamycin for these foot ulcers, and will be discharged home with visiting nursing care for b.i.d. wet-to-dry dressing changes. He will follow up with Jerold Cristopher Blazon, M.D. in one to two weeks, go home with visiting nurse care, and will need to see his nephrologist, vascular surgeons, primary care provider, and Bariatric Surgery following discharge. | Has this patient ever been treated with nitroglycerin | {
"answer_end": [
1004
],
"answer_start": [
937
],
"text": [
"Procrit, Zantac, nitroglycerin p.r.n., and NPH 80 q.a.m. and q.p.m."
]
} |
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 patient's current dose does the patient take of her insulin nph | {
"answer_end": [
1669
],
"answer_start": [
1634
],
"text": [
"Insulin NPH 100 units sub-q q.a.m.,"
]
} |
Ms. Veltin is a 72 year old woman with a PAST MEDICAL HISTORY significant for coronary artery disease, diabetes, and hypertension. On admission, her CURRENT MEDICATIONS included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., simvastatin 10 q.d., metformin 500 q.d., and NPH 43 q.a.m. and 24 q.p.m., while her PAST MEDICAL HISTORY was significant for diabetes for which she took insulin and checked her sugars at home which ran 170 range to 200 range. During admission, she was maintained on metformin, her blood pressure was controlled with Lisinopril at 40 milligrams, she was given nifedipine extended release 120 q.d., and her sugars at home on her regimen of 43 q.a.m. and 24 q.p.m. were in control. She was also maintained on her aspirin and simvastatin, and given Lasix 20 q.d. times seven days and four liters through admission with Lasix at 40 intravenously. Her cardiovascular evaluation showed three vessel disease, diastolic dysfunction, and pulmonary artery systolic pressure of 36 plus RA, but no wall motion abnormalities. Her blood pressure regimen was advanced with the addition of Atenolol 50 b.i.d. and titration up to 120 milligrams q.d. of nifedipine extended release. For congestive heart failure, she diuresed approximately four liters through admission with Lasix at 40 intravenously and would be discharged on a seven day course of Lasix at 20 p.o. q.d. Pulmonary evaluation showed hypoxia on admission to 85% on room air, D-dymer greater than 1000, V/Q scan low probability, negative lower extremity noninvasives, chest CT without interstitial lung disease, and pulmonary function tests consistent with restrictive picture. Endocrine evaluation revealed that she was maintained on metformin during admission and also on half of her dose of NPH given her decreased p.o. intake. She took insulin and checked her sugars at home, which were 170 to 200, and she was discharged on her normal regimen of 43 q.a.m. and 24 q.p.m. of NPH. Discharge medications included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., nifedipine extended release 120 q.d., metformin 500 q.d., NPH 43 q.a.m. and 24 q.p.m., simvastatin 10 q.d., aspirin 325 q.d., and Lasix 20 milligrams p.o. q.d. times seven days. She was discharged in stable condition on March, 2000 and will follow up with Dr. Nakajima, her primary care doctor, and Dr. Klang, her cardiologist. | Has the patient taken medication for diabetes | {
"answer_end": [
1872
],
"answer_start": [
1824
],
"text": [
"She took insulin and checked her sugars at home,"
]
} |
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 this patient ever been treated with famotidine. | {
"answer_end": [
1103
],
"answer_start": [
1057
],
"text": [
"Toprol, lisinopril, albuterol, and famotidine."
]
} |
Mr. Legions is a 54 year old professor who presented to Menjack Hospital Medical Center with recurrent substernal chest pain one day after coronary artery bypass graft (5 vessel bypass) 8 years ago. His coronary risk factors include a positive family history and a previous diagnosis of hyperlipidemia. He was given Lovastatin 40 mg q q.m. and 20 mg q p.m., as well as enteric-coated aspirin one tablet q day. At Skaggssin Hospital, he was given IV nitroglycerin, IV heparin, Nifedipine SL, and morphine, in addition to aspirin and Lovastatin. The patient's pain was relieved with four sublingual nitroglycerin and an EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. He was treated symptomatically with Tylenol and started on Biaxin 500 mg po bid, and also received a five day course of oral Biaxin with Cholestyramine one packet po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn. The patient had episodes of fever, achieving a maximum temperature of 101.4, and a chest x-ray on 0/26/95 demonstrated evidence of early congestive heart failure. The patient was treated with daily doses of IV Lasix with resolution of his rales. He was admitted to the Cardiac Intensive Care Unit on IV heparin and nitroglycerine as well as continuation of his aspirin and Lovastatin. His pain was treated with morphine sulfate and relieved with four sublingual nitroglycerin. An EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. After 24 hours pain-free, the patient was transferred to the Cardiac Step-Down floor and the IV nitroglycerin and IV heparin were discontinued. An echocardiogram demonstrated inferior and posterior hypokinesis with an ejection fraction of approximately 46%, and the patient underwent a submax MIBI to assess coronary perfusion of the heart. The exercise component of this examination demonstrated EKG changes consistent with ischemic coronary flow. Nuclear imaging demonstrated a fixed apical lateral defect in the patient's heart consistent with a healed or healing transmural infarct. The patient also complained of progressive anterior and lateral thigh pain, symptoms consistent with an upper respiratory viral infection, and rales 4 to 5 cm above the bases bilaterally. He was discharged to home with followup in MERH under Drs. Dwayne Ariel Bremme with the medications Enteric-coated aspirin 325 mg po q day, Cholestyramine one packet po q hs, Lovastatin 20 mg po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn with chest pain. | Previous nitroglycerine | {
"answer_end": [
1336
],
"answer_start": [
1267
],
"text": [
"nitroglycerine as well as continuation of his aspirin and Lovastatin."
]
} |
The 68-year-old female patient presented with lower extremity swelling and erythema at the lower pole of her sternal wound, and her past medical history includes hypertension, diabetes, hypothyroidism, hypercholesterolemia, COPD, GERD, depression, history of GI bleed on Coumadin therapy, and pulmonary hypertension. On admission, the patient was started on 1. Toprol 25 p.o. daily., 2. Valsartan 40 mg p.o. daily., 3. Aspirin 81 mg p.o. daily., 4. Plavix 75 mg p.o. daily., 6. Lasix 40 mg p.o. b.i.d., 7. Spironolactone 25 mg p.o. daily., 8. Simvastatin 20 mg p.o. daily., 9. Nortriptyline 50 mg p.o. daily., 10. Fluoxetine 20 mg p.o. daily., 11. Synthroid 88 mcg p.o. daily., and a Lasix drip and Diuril with antibiotics for coverage of possible lower extremity cellulitis. After transthoracic echocardiogram revealed an ejection fraction of 40% to 45% and a stable mitral valve, the patient was started on a Lasix drip and Diuril with improvement of symptoms, and the Pulmonary team was consulted and recommended regimen of Advair and steroid taper for her COPD, and she was empirically covered for pneumonia with levofloxacin and Flagyl and continued to diurese well on a Lasix drip. Her preadmission cardiac meds, as well as her Coumadin for atrial fibrillation, were restarted, and the patient required ongoing aggressive diuresis to eventually achieve a fluid balance of is negative 1 liter daily. Liver function tests, as well as amylase and lipase, were checked and noted to be normal, and the patient's nausea and vomiting resolved when her bowels began to move. The patient was discharged to home in good condition on hospital day #8 with medications including Enteric-coated aspirin 81 mg p.o. daily, Zetia 10 mg p.o. daily, Fluoxetine 20 mg p.o. daily, Advair Diskus one puff nebulized b.i.d., Lasix 60 mg p.o. b.i.d., NPH insulin 30 units subcutaneously q.p.m., NPH insulin 20 units subcutaneously q.a.m., Potassium slow release 30 mEq p.o. daily, Levofloxacin 500 mg p.o. q.24 h. x4 doses, Levothyroxine 88 mcg p.o. daily, Toprol-XL 100 mg p.o. daily, Nortriptyline 50 mg p.o. nightly, Prednisone taper 30 mg q.24 h. x3 doses, 20 mg q.24 h. x3 doses followed by a 10 mg q.24 h. x3 doses, then 5 mg q.24 h. x3 doses, Simvastatin 40 mg p.o. nightly, Diovan 20 mg p.o. daily, and Coumadin to be taken as directed to maintain INR 2 to 2.5 for atrial fibrillation, with followup appointments with her cardiologist, Dr. Schwarzkopf in one to two weeks with her cardiac surgeon, Dr. Carlough in four to six weeks, and VNA will monitor her vital signs, weight, and wounds, and the patient's INR and Coumadin dosing will be followed by S Community Hospital Anticoagulation Service at 300-135-5841. | Has the patient had levofloxacin in the past | {
"answer_end": [
1187
],
"answer_start": [
1112
],
"text": [
"with levofloxacin and Flagyl and continued to diurese well on a Lasix drip."
]
} |
Mrs. Wetterauer is a 54-year-old female with coronary artery disease status post inferior myocardial infarction in March of 1997, with sick sinus syndrome, status post permanent pacemaker placement, and paroxysmal atrial fibrillation controlled with amiodarone; also with history of diabetes mellitus and hypertension. On 1/11, she experienced severe respiratory distress and was unable to be intubated on the field. She was ultimately intubated at Sirose, and an echocardiogram showed an ejection fraction of 25 to 30 percent with flat CKs. She was diuresed six liters and a right heart catheterization showed a pulmonary artery pressure of 40/15, wedge of 12, and cardiac output of 5.2. Hemodynamics indicated her cardiac output was dependent on her SVR. At the outside hospital, a right upper lobe infiltrate was noted and she was given gentamicin 250 mg times one, and clindamycin 600 mg. She was diagnosed with pneumonia and treated with clindamycin, which caused resolution of her white count. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. Her last admission was on 10/6 for atypical chest pain, and she was placed on Bactrim Double Strength b.i.d. times a total of seven days, as well as Lovenox 60 mg b.i.d., aspirin 325 p.o. q.d., lisinopril 40 mg p.o. b.i.d., digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. Home medications include amiodarone 200 mg p.o. q.d., Glyburide 5 mg p.o. q.d., Lopressor 50 mg p.o. b.i.d., Prempro 0.625/2.5 p.o. q.d., lisinopril 40 mg p.o. q.d., Coumadin, nitroglycerin sublingual, Zantac, beclomethasone, and Ventolin. Medications on transfer, Lovenox 60 mg b.i.d., aspirin 325 p.o. q.8, digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. The patient was also placed on Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Glyburide 5 mg p.o. q.d., Lasix 20 mg p.o. q.d., atenolol 150 mg p.o. q.d., diltiazem CD 240 mg p.o. q.d., and resolved with 20 mg of Lasix p.o. q.d. Mrs. Wetterauer was admitted to the Aley Coness-o Meoak Medical Center for paroxysmal atrial fibrillation controlled with amiodarone, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma. For her anxiety, the patient was treated acutely with Ativan and her problem resolved quite well, and she became more comfortable in the hospital. Diabetes Mellitus was managed with Glyburide held initially on admission, covered with insulin sliding scale, and restarted on discharge. Edema was managed with Lasix 20 mg p.o. q.d. and resolved with 20 mg of Lasix p.o. q.d. Urinary Tract Infection was managed with antibiotics. She was discharged with medications including amiodarone 200 mg p.o. q.d., lisinopril 40 mg p.o. b.i.d., Tapazole 10 mg | Has the patient had multiple albuterol prescriptions | {
"answer_end": [
1442
],
"answer_start": [
1432
],
"text": [
"Albuterol,"
]
} |
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 is her current dose of toprol-xl | {
"answer_end": [
1299
],
"answer_start": [
1212
],
"text": [
"Metformin 500 mg q.p.m., Toprol-XL 25 mg daily and oxycodone 5-10 mg q.4h. p.r.n. pain."
]
} |
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. | What is the current dose of packed red cells | {
"answer_end": [
1074
],
"answer_start": [
1003
],
"text": [
"for her ischemia, she was transfused with one unit of packed red cells."
]
} |
The patient is a 76-year-old male with a history of diabetes, hypertension, and CAD status post MI in 2000 who presented to the Emergency Room on 0/0/06 with an ST elevation MI. In the Cath Lab, he was given bicarb, placed on the epi drip, given Lasix and intubated. He was thought to aspirate at the time of intubation secondary to vomiting. A bedside echo revealed global hypokinesis with an EF of 35% and he was placed on a balloon pump, dopamine 16, amio 1, propofol 1, and Integrilin and brought to the floor. On the floor, his blood pressures were difficult to control and his wedge pressure readings indicated a wedge pressure of 47. His MAPs to keep them over 60 required max dopamine, max Levophed, epinephrine and dobutamine. He was arrested multiple times in V-Tach requiring CPR and cardioversion and was found to have in-stent thrombosis in his LAD which was aspirated and bare-metal stent was placed in his LAD and another stent was placed in his diag-2. His family was aware of his prognosis and was there at the time of his arrest at 3:30 in the morning. CPR was initiated and ACLS was done until the family decided to terminate the ACLS and the time of death was 3:47 a.m. on 0/0/06. The cause of death was thought to be cardiogenic shock secondary to ST elevation MI. | Has this patient ever been on levophed | {
"answer_end": [
735
],
"answer_start": [
671
],
"text": [
"required max dopamine, max Levophed, epinephrine and dobutamine."
]
} |
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. | What are the different medications that have been used on this patient for pain | {
"answer_end": [
476
],
"answer_start": [
404
],
"text": [
"ROXICET ELIXIR (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain,"
]
} |
The patient is a 60 year-old woman with adult onset diabetes mellitus, hypertension, and elevated cholesterol admitted with chest pain, bradycardia, and decreased blood pressure. When her blood pressure is elevated, she takes Nifedipine and the pain became three to four out of ten, so she took Cardizem without relief and called EMS. The pain was relieved with the EMTs gave nitroglycerin times two and they found her to have blood pressure of 190/100, heart rate 76, and normal sinus rhythm. They gave two nitrospray, blood pressure decreased to 150/80, heart rate 76, and after two minutes in the vehicle, she had sinus bradycardia at 30-40, blood pressure 120/80. She was given 0.5 mg of Atropine times one without any affect and brought to the hospital with a systolic blood pressure of 100, then suddenly she had bradycardia with heart rate of 30-40 and systolic blood pressure of 75. She was given intravenous fluids and Atropine 0.5 mg times one which increased her blood pressure systolic to 100 and her heart rate increased to 60. On admission, she was given Nifedipine 10 mg p.r.n. for elevated blood pressure, Lasix 20 mg q. day, Glucotrol 15 mg q. day, Cardizem 300 mg q. day, Coumadin 3.75 mg q. day, Colace 100 mg b.i.d., and Iron 325 mg q. day. On discharge, she was given Aspirin 325 mg q. day, Atenolol 50 mg q. day, Lisinopril 10 mg q. day, Pravachol 20 mg q. day, Glucotrol XL 15 mg q. AM, Lasix 20 mg q. day, and Nitroglycerin tablets sublingual p.r.n. chest pain. She underwent exercise tolerance test on a standard Bruce protocol and angiography which showed left main OK, LAD proximal 20%, D2 60%, ostial 90% mid, left circumflex mid 30%, OM2 distal 60-70%, OM1 mild diffuse disease. She underwent PTCA of her diagonal two which went from 90% to 0% stenosis and she received Heparin overnight and the sheaths were pulled on the following day. She is to follow-up in the VERAREA UNIVERSITY HOSPITAL Clinic with Dr. Van Rothenberg. | What is the reason this patient is on nitroglycerin tablets | {
"answer_end": [
1485
],
"answer_start": [
1434
],
"text": [
"Nitroglycerin tablets sublingual p.r.n. chest pain."
]
} |
Patient was admitted to the All Hospital surgery service on 0/12/2006 after undergoing laparoscopic gastric banding. No concerning intraoperative events occurred; please see dictated operative note for details. The patient was transferred to the floor from the PACU in stable condition and had adequate pain control and no issues overnight into POD1. The patient was started on a Stage I diet which was tolerated and then advanced to clears and discharged to home a Stage II diet. The incision was C/D/I, with no evidence of hematoma collection or infection. The patient was given explicit instructions to follow-up in clinic with Dr. Mcmenamy in two weeks and instructed to take ROXICET ELIXIR (OXYCODONE+APAP LIQUID) 5 MILLILITERS PO Q4H PRN Pain, PHENERGAN (PROMETHAZINE HCL) 25 MG PR Q6H PRN Nausea and MULTIVITAMIN THERAPEUTIC (THERAPEUTIC MULTIVI...) 1 TAB PO DAILY Instructions: chewable. The patient was also instructed not to drive or consume alcohol while taking pain medications and to crush pills, open capsules, or take elixirs. The patient was discharged in stable condition, ambulating and voiding independently, and with adequate pain control. | What is the current dose of the patient's roxicet elixir ( oxycodone+apap liquid ) | {
"answer_end": [
749
],
"answer_start": [
680
],
"text": [
"ROXICET ELIXIR (OXYCODONE+APAP LIQUID) 5 MILLILITERS PO Q4H PRN Pain,"
]
} |
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. | How often does the patient take celexa | {
"answer_end": [
1290
],
"answer_start": [
1222
],
"text": [
"atorvastatin 10 mg q.d., Celexa 20 mg q.d., ibuprofen 800 mg b.i.d.,"
]
} |
The patient is a 40 year old female with a history of cholelithiasis who was recently discharged from Asce Medical Center after an incisional hernia repair. She soon after noted onset of right upper quadrant pain, vomiting, and fever and was readmitted with an ultrasound showing two 8-9 mm gallstones in the right upper quadrant. She was treated with intravenous antibiotics but deferred surgery at that time and was discharged home after defervescing. Approximately six weeks prior to admission, she was seen in the Emergency Ward for recurrent right upper quadrant pain without nausea, vomiting, or fever. She was subsequently seen by Dr. Bellman in the Chica Onant Hospital and a cholecystectomy was scheduled on a routine basis. On admission, the patient was afebrile with stable vital signs. Her EKG showed normal sinus rhythm, her chest X-Ray was clear, and her laboratory examination was within normal limits. She was placed under general anesthesia and her intubation was particularly difficult secondary to obesity requiring fiberoptic intubation and Anesthesia elected to place both an A-line and a central venous access. She then underwent a very uncomplicated cholecystectomy and was taken to the Recovery Room in stable condition. She received two doses of Gentamicin as prophylaxis post-operatively and had an unremarkable post-operative course. She was discharged to home on post-operative day number five with an appointment to follow-up in the Ingtondi Community Healthcare. | general anesthesia | {
"answer_end": [
957
],
"answer_start": [
918
],
"text": [
"She was placed under general anesthesia"
]
} |
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. | has the patient had digoxin | {
"answer_end": [
1478
],
"answer_start": [
1453
],
"text": [
"Digoxin 0.375 mg p.o. qd,"
]
} |
The patient is a 75-year-old male with a history of coronary artery disease, status post five catheterization with a pacemaker in place, arthritis, gout, benign prostatic hypertrophy, hypertension, and myelodysplasia who presented with a history of lower gastrointestinal bleeds. He was transfused with four units of packed red blood cells and then transferred to the Siter Calvty Valley Hospital for further evaluation and treatment. On admission, his hematocrit was 32.9 and subsequent serial hematocrits over the following two days were stable. A right hemicolectomy was performed on hospital day number three to prevent further episodes and the procedure and recovery were unremarkable. He was started on sips on postoperative day number one and clear liquids on postoperative day number two. He was advanced to a regular house diet on postoperative day number four and was discharged to home with services on the day of discharge. The patient was seen by his cardiologist, Dr. Poette throughout his hospitalization and was noted to have a run of V-tach 10 beats, asymptomatic, no chest pain or discomfort, no shortness of breath. He was discharged on Allopurinol 300 mg p.o. q.d., atenolol 25 mg p.o. q.d., Colace 100 mg p.o. b.i.d. p.r.n. constipation, Percocet 1-2 tablets p.o. q.4h. p.r.n. pain, Zantac 150 mg p.o. b.i.d., and Flomax 0.8 mg p.o. q.d. He will follow up with Dr. Weigold, his hematologist, in 2-4 weeks and Dr. Condiff on 8/28/02. | Has this patient ever been prescribed atenolol | {
"answer_end": [
1211
],
"answer_start": [
1135
],
"text": [
"He was discharged on Allopurinol 300 mg p.o. q.d., atenolol 25 mg p.o. q.d.,"
]
} |
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. | Why did the patient have aldactone | {
"answer_end": [
861
],
"answer_start": [
786
],
"text": [
"Given his potassium, which was always borderline low in the 33 or 35 range,"
]
} |
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. | Why did the patient need chloral hydrate | {
"answer_end": [
1452
],
"answer_start": [
1374
],
"text": [
"Chloral hydrate 500 mg p.o. q.h.s. p.r.n. insomnia, Clonopin 1 mg p.o. t.i.d.,"
]
} |
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 the patient ever had ambien. | {
"answer_end": [
1546
],
"answer_start": [
1431
],
"text": [
"The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien,"
]
} |
The patient was admitted on 4/12/04 with a right plantar surface neurotrophic ulcer, low-grade fevers and chills, and a history of diabetes mellitus, hypertension, distant past of pancreatitis, gout, neuropathy, high cholesterol, and chronic renal insufficiency. Significant labs at the time of admission included a potassium of 4.3, BUN of 38, creatinine of 3.2, and blood glucose of 187. The patient was started on 1. Lantus 100 mg q.p.m., 2. Humalog 20 units q.p.m., 4. Neurontin 300 mg t.i.d., 5. Lisinopril 40 mg q.d., 6. Allopurinol 300 mg q.d., 7. Hydrochlorothiazide 25 mg q.d., 8. Zocor 20 mg q.d., 9. TriCor 50 mg b.i.d., 10. Atenolol 25 mg q.d., 11. Eyedrops prednisolone and atropine, and 12. iron supplementation. The patient underwent an amputation of the third and fourth toe as well as metatarsal heads, and was started on Dr. Tosco's suggested antibiotics, vancomycin, levofloxacin, and Flagyl. To manage temperature greater than 101, the patient was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n., allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient was seen by Dr. Ulvan in the renal staff and by the diabetes management service by Dr. Clint Holets. Postoperative lab checkup revealed that the patient's creatinine bumped to 4.9 with a BUN of 61, and the renal service was consulted. The patient was given Lopressor 100 mg b.i.d. to control the blood pressure, and was eventually started on PhosLo and Ferrlecit as well as Epogen 10,000 units q. week. Levofloxacin was continued for a one week course, and the patient was discharged to the rehab facility with Tylenol 650 to 1000 mg p.o. q.4h. p.r.n. for temperature greater than 101, allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Lopressor 100 mg p.o. b.i.d., PhosLo 1334 mg p.o. q.a.c., Colace 100 mg p.o. b.i.d., Epogen 10,000 units delivered subcuticularly q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient is to be followed up at the rehab facility at Ing Mansy General Hospital and should follow up with the renal service and Dr. Knaub in two to three weeks and one to two weeks, respectively. The | has the patient had iron | {
"answer_end": [
1219
],
"answer_start": [
1147
],
"text": [
"iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain,"
]
} |
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty. | has there been a prior prozac | {
"answer_end": [
2060
],
"answer_start": [
2026
],
"text": [
"including amitriptyline, Flexeril,"
]
} |
A 77-year-old woman presented to the ED with sudden onset of severe sharp chest pain, diaphoresis, and nausea; she was given nitro, hydralazine, SL nitro, and a nitro drip, and her pain was relieved. Cardiac catheterization showed no change from prior studies, but pulmonary hypertension was noted, and the patient was treated with heparin, ASA/Plavix (home dose), and uptitrated labetalol for BP control. A PE CT showed a pulmonary nodule, and the patient was discharged home on ACETYLSALICYLIC ACID 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 80 MG PO BEDTIME, CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY, PLAVIX (CLOPIDOGREL) 75 MG PO QAM, NEXIUM (ESOMEPRAZOLE) 20 MG PO QAM, LASIX (FUROSEMIDE) 40 MG PO QAM, INSULIN 70/30 HUMAN 40 UNITS SC BID, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, LABETALOL HCL 400 MG PO Q8H Starting Tonight (2/22), LEVOXYL (LEVOTHYROXINE SODIUM) 112 MCG PO DAILY, OXYCODONE 5-10 MG PO Q4H PRN Pain, ALDACTONE (SPIRONOLACTONE) 12.5 MG PO QAM, and DIOVAN (VALSARTAN) 160 MG PO DAILY, with instructions to take medications consistently with meals or on an empty stomach and to assess blood sugars and titrate insulin as per her doctor's instructions. She was to monitor her electrolytes with VNA in 1 week, continue diabetes teaching, and work with her VNA for aggressive diabetes management, with follow up with her outpt PCP and endocrinologist for titration of insulin and optimization of insulin regimen, as well as a pulmonary consult to evaluate for primary pulmonary disease, and a repeat chest CT in 6-12 months to follow up the pulmonary nodule. | Has the pt. ever been on labetalol before | {
"answer_end": [
405
],
"answer_start": [
369
],
"text": [
"uptitrated labetalol for BP control."
]
} |
Mr. Barriger is a 73-year-old gentleman who was admitted to the Cardiac Step-Down Floor after being a restrained driver in a motor vehicle collision. His past medical history includes myocardial infarction, hypertension, hypercholesterolemia, diabetes, renal cyst, and cataract, and a past surgical history of coronary stenting and cataract removal. He was prescribed Glyburide 100 mg p.o. b.i.d., Metformin 500 mg p.o. b.i.d., Aspirin 81 mg p.o. q. day., Zocor 80 mg p.o. q. day., Plavix 75 mg p.o. q. day., Prilosec 20 mg p.o. q. day., Isosorbide dinitrate 40 mg p.o. t.i.d., Atenolol 100 mg p.o. q. day., Tylenol 650 mg p.o. q.4h. p.r.n. pain., Colace 100 mg p.o. b.i.d., Ativan 1-2 mg IV p.r.n. anxiety., Oxycodone 5-10 mg p.o. q.6h. p.r.n. pain., Senna tablets 2 p.o. b.i.d., Keflex 250 mg p.o. q.i.d. x12 doses. Keflex should be completed on Monday night., Ambien 5 mg p.o. q.h.s., Tessalon 100 mg p.o. t.i.d. p.r.n. cough., Novalog slides., Maalox 1-2 tabs p.o. q.6h. p.r.n. pain. and Dilaudid 1-2 mg IV q.4h. p.r.n. pain. for pain control. He was also put on Lovenox 40 mg sub-Q. q. day for DVT prophylaxis and aspirin and Plavix for secondary cardiac and neurological prophylaxis. He was also started on Ancef 1 gm q.8h. with a PICC line which was placed later on the day. His pain was well controlled with the combination of Dilaudid and oxycodone and he was encouraged to take several deep breaths per hour to reduce the risk of atelectasis or pneumonia. He was seen by numerous consultants, and his white count improved dramatically and he was afebrile for more than 48 hours while on the Ancef. He was discharged to rehab with appointments with the mentioned doctors. | Has the patient had previous prilosec | {
"answer_end": [
537
],
"answer_start": [
509
],
"text": [
"Prilosec 20 mg p.o. q. day.,"
]
} |
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 this patient ever tried taxol. | {
"answer_end": [
405
],
"answer_start": [
387
],
"text": [
"with weekly Taxol."
]
} |
The 43 year old male patient presented with atypical chest pain radiating to the left arm, diaphoresis, nausea, and mild shortness of breath. An EKG with T-wave inversion (TWI) concerning for anterolateral ischemia was also noted, and a Troponin I at ASH was negative (0.04 and 0.05) but the pain persisted, requiring a nitroglycerin (NTG) drip. The patient was admitted to the ward and started on ECASA (Aspirin Enteric Coated) 81 mg PO qd, ferrous sulfate 325 mg PO tid, furosemide (Lasix) 60 mg PO bid, hydralazine HCL 90 mg PO tid, labetalol HCL 600 mg PO tid, nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain hold if SBP <100, claritin (loratadine) 10 mg PO qd, losartan (Cozaar) 100 mg PO qd hold if SBP 95, metformin 850 mg PO bid, and Vytorin 10/40 (ezetimibe 10 mg - simvastatin 40 mg) 1 tab PO qd. An Adenosine MIBI showed LV dilation with an ejection fraction of 44%. The patient remained chest pain free overnight and the NTG drip was tapered, with hydralazine and labetalol increased. The patient was discharged with instructions to follow up with Dr. Pulfrey for BP check within 1 week, take discharge medications as prescribed, comply with a low cholesterol, low fat, and <2g sodium diet, and seek medical attention for worsening chest pain, shortness of breath, and marked weight gain, not to resume the Norvasc or Enalapril until instructed to by Dr. Kozola, and to consider further w/u anemia. | What is the patient's current dose does the patient take of her ecasa ( aspirin enteric coated ) | {
"answer_end": [
441
],
"answer_start": [
398
],
"text": [
"ECASA (Aspirin Enteric Coated) 81 mg PO qd,"
]
} |
Patient TEWA, GERMAN M, a 74-year-old African American female with a history of NYHA III CHF (EF 45%), PHT, HTN-CMP, and obesity, was admitted to CAR service on 1/20/2005 for CHF exacerbation and UTI and was discharged on 4/28/2005 with Full Code status. She was prescribed ALLOPURINOL 100 MG PO BID, FERROUS SULFATE 325 MG PO QD, LASIX (FUROSEMIDE) 60 MG PO BID starting today (8/27), HYDRALAZINE HCL 10 MG PO TID (hold if SBP below 90), ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID (hold if SBP below 90), LISINOPRIL 20 MG PO QD (hold if SBP below 90), LIPITOR (ATORVASTATIN) 10 MG PO QD, PROTONIX (PANTOPRAZOLE) 40 MG PO QD, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, LEVAQUIN (LEVOFLOXACIN) 250 MG PO QD, and ACETYLSALICYLIC ACID 325 MG PO QD. Override notices were added on 5/12/05, 10/29/05, and 10/29/05 on order for KCL IMMEDIATE RELEASE PO (ref #03030471, 01642329, 91907761, 15927551) and KCL IV (ref #78178294) for POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE. Food/Drug Interaction Instruction to avoid milk and antacid, take consistently with meals or on empty stomach, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose (if on tube feeds, please cycle (hold 1 hr before to 2 hr after) and take 2 hours before or 2 hours after dairy products) was provided, as well as fluid restriction and diurese aggressively with lasix 100 bid, replete lytes, keeping in mind CRI, cont BB, ACEI, and added hydralazine/isordil for CAD, hyperlipidemia: BB, ACEI, statin, ASA; RENAL: CRI with anemia; HEME: Anemia - Given aranesp, FeSO4; HTN: BB, ACEI; ID: UTI, E coli in Ucx, sensitivities pending; and empirically tx with Keflex, changed empirically on HD4 to levo. RHEUM: Gout - allopurinol. The patient was discharged in a satisfactory condition. | has there been a prior toprol xl (metoprolol succinate extended release) | {
"answer_end": [
689
],
"answer_start": [
627
],
"text": [
"TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD,"
]
} |
The patient, TABIOS, MARLIN, was admitted to the hospital with a diagnosis of congestive heart failure. Upon discharge, the patient was prescribed Atenolol 100 MG PO QD, Lasix (Furosemide) 40 MG PO QD, Reglan (Metoclopramide HCl) 10 MG PO TID, Coumadin (Warfarin Sodium) 3.75 MG PO QPM, Simvastatin 20 MG PO QHS, Insulin 70/30 (Human) 10 UNITS QAM; 0 UNITS QPM SC, Cozaar (Losartan) 100 MG PO QD, and Protonex (Pantoprazole) 40 MG PO QD, with a potentially serious interaction of Simvastatin and Warfarin. The patient was also instructed to follow a fluid restriction of two liters, a diet low in cholesterol and saturated fat, and a two gram Sodium diet. In addition, the patient was informed to take the Reglan with warm water, separately from other pills before meals and to avoid grapefruit unless instructed otherwise. The patient's insulin regiment was modified and the Beta Blocker was changed to once a day Atenolol, and she was instructed to switch to 10 units of 70/30 insulin the morning. The patient was put on a Full Code status and was discharged with instructions to walk as tolerated and to follow up with Asselmeier in 1-2 weeks and to arrange for INR to be drawn on 8/16/04 with follow up INR's to be drawn every 7 days. The patient was also advised to be aware of the potentially serious interaction between Simvastatin and Warfarin, discontinue Metoprolol and Lisinopril, start Cozaar and Atenolol, increase Reglan dose, and VNA for diabetes management, CHF management, and medical compliance. | has there been a prior coumadin ( warfarin sodium ) | {
"answer_end": [
286
],
"answer_start": [
244
],
"text": [
"Coumadin (Warfarin Sodium) 3.75 MG PO QPM,"
]
} |
Patient Alequin, Garland, a 57-year-old female with a complex medical history including squamous cell lung cancer, cirrhosis, COPD, HTN, PVD, seizure disorder, history of SDH, large abdominal ventral hernia, and chronic back pain, was admitted to the ED obtunded with decreased BP. She had received all her medications as prescribed in the morning at her nursing home and received Thiamine HCL 100 mg PO daily and Narcan in the ED, becoming more responsive and uncomfortable after Narcan with an elevated ammonia level of 233. To manage her mental status, the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29) and her narcotic dose was avoided. Pain was effectively controlled with MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Celecoxib 100 mg PO daily Starting Today (5/29) PRN Pain, and a Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily. She was prescribed Vitamin C (Ascorbic Acid) 500 mg PO BID, Folate (Folic Acid) 1 mg PO daily, Lasix (Furosemide) 40 mg PO daily, Flagyl (Metronidazole) 500 mg PO q8h, Aldactone (Spironolactone) 75 mg PO BID with food/drug interaction instruction to give with meals, KCL IV (ref #403310506) with serious interaction of Spironolactone & Potassium Chloride with reason for override monitoring, Thiamine HCL 100 mg PO daily, Multivitamin Therapeutic (Therapeutic Multivitamin) 1 tab PO daily, MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Flovent HFA (Fluticasone Propionate) 220 mcg INH BID, Celecoxib 100 mg PO daily, Keppra (Levetiracetam) 1,000 mg PO BID, Caltrate 600 + D (Calcium Carbonate 1,500 mg (...)), Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily, Novolog (Insulin Aspart) sliding scale (subcutaneously) SC AC with instructions to give 0-10 units subcutaneously based on BS, Maalox-Tablets Quick Dissolve/Chewable 1-2 tab PO Q6H PRN Upset Stomach, Vitamin K (Phytonadione) 5 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO daily with food/drug interaction instruction to take consistently with meals or on empty stomach, Magnesium Oxide 420 mg PO BID, Metronidazol starting on HD 1, and Vancomycin until speciation of blood cultures. Blood cultures were positive for coag negative staph in 2/4. She was also given Flovent for her known COPD and was discharged with instructions to complete a 14-day course of Cipro and Flagyl and a few changes in her medications, including MSIR every 4 hr as needed, Celebrex, and Lidoderm patch. Follow up with Dr. Vargas, Dr. Megeath, Dr. Blandin, and Dr. Pfleider as scheduled, and with PT at nursing home. Blood counts and calcium should be checked on Monday 3/21 and next week respectively. | Previous lactulose | {
"answer_end": [
631
],
"answer_start": [
556
],
"text": [
"the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29)"
]
} |
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 the patient ever tried gemfibrozil | {
"answer_end": [
883
],
"answer_start": [
823
],
"text": [
"His Lipitor was decreased to 20mg due to rhabdomylosis risk,"
]
} |
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 current dose of percocet | {
"answer_end": [
1338
],
"answer_start": [
1284
],
"text": [
"Percocet 325 mg/5 mg tablets one tablet q.6 h. p.r.n.,"
]
} |
This is a 72 year old black female with a history of hypertension, angina, adult onset diabetes, and recurrent syncopal events who was treated with Dilantin for less than a year in 1970 and her last episode was in 1989. She was given Nitro Paste and 1 amp of D50 when she experienced a syncopal event on the morning of admission and her fingerstick glucose was checked. Her medications on admission include aspirin one tablet q d, Questran one pack q d, Micronase 5 mg po q d, Betaxolol eye drops bid to each eye, Pilocarpine eye drops tid to each eye, and eye drops bid to each eye. She also receives monthly Vitamin B12 injections and takes nitroglycerin with chest pain. Physical examination revealed pinpoint constriction of her pupils secondary to her glaucoma eyedrops, bibasilar, coarse crackles in the chest, no jugular venous distention, and nonfocal neurologic exam. Laboratory data includes sodium of 143, potassium of 4.3, chloride of 109, bicarbonate of 20, BUN of 21, creatinine of 1.0, glucose of 160, hematocrit of 43.4, white count of 6.45, and normal coagulation factors. Chest X ray showed a calcific aorta, C spine X ray and head CT were negative, and EKG showed no changes from her baseline. The patient was started on Isordil and Lopressor empirically but these were discontinued and her chest pain is relieved with nitroglycerin. She was discharged to home with plans for a repeat 24 hour Holter as an outpatient with diagnoses of syncope, borderline type II diabetes, stable exertional angina, and glaucoma. Discharge medications include aspirin one tablet po q d, Questran one package po q d, Pilocarpine eye drops tid per eye, Betaxolol eye drops bid per eye, eye drops bid per eye, sublingual nitroglycerin prn chest pain, and Naprosyn 375 mg tid prn. | What adult onset diabetes medications have ever been prescribed for pt. in the VA or mentioned in the record | {
"answer_end": [
476
],
"answer_start": [
454
],
"text": [
"Micronase 5 mg po q d,"
]
} |
The 90+-year-old female patient presented to the Trinmo Rybay Bethmorgreene Burgstern Medical University Of Medical Center Department on 5/1/06 with an intermittently cold and blue right foot, and gangrene was noticed in the second and third right lower extremity toes. She had significant medical issues such as dementia, coronary artery disease, diabetes, and PVOD. She underwent and tolerated a right AKA on 7/8/06 without any complications, and after recovery from anesthesia was admitted to the general care floor. Her diet was advanced as tolerated and the pain was well controlled with oral pain medications and she was evaluated by physical therapy. She was treated with perioperative ancef and switched to one week of p.o. linezolid just prior to discharge. At the time of discharge, the patient was afebrile, vital signs stable, with the right AKA stump well healed and with mild erythema inferior to the incision. Her discharge medications included Trazodone 50 mg nightly, Celexa 20 mg daily, Colace 100 mg b.i.d., Hydrochlorothiazide 25 mg daily, Novolog sliding scale, Lantus 20 units subcutaneously q.a.m., FiberCon one tablet, MVI daily, Synthroid 25 mcg daily, Linezolid 600 mg p.o. q.12h. x10 doses starting today, Zyprexa 2.5 mg p.o. q.p.m., and Tylenol Elixir 1000 mg p.o. q.6h. p.r.n. pain and Lactulose 30 mL p.o. daily p.r.n. constipation. She was discharged to her skilled nursing facility with plans to follow up with her primary care physician and Dr. Wynder in one to two weeks. The patient is DNR/DNI. | What is the dosage of synthroid | {
"answer_end": [
1177
],
"answer_start": [
1154
],
"text": [
"Synthroid 25 mcg 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 been prescribed lisinopril | {
"answer_end": [
946
],
"answer_start": [
919
],
"text": [
"Diltiazem 240 mg p.o. q.d.,"
]
} |
This is a 59-year-old female with a history of rheumatic heart disease, endocarditis, diabetes mellitus, hypertension, and congestive heart failure who presented with increasing shortness of breath, nausea, vomiting, and abdominal pain. She was given recent Levaquin for an upper respiratory tract infection, then started on Flagyl for a possible C. difficile infection and was diuresed with IV Lasix with good output per report. She complained of 10/10 abdominal pain and was given some Dilaudid. Her hematocrit at one point required two units of packed red blood cells, and she was placed on a heparin drip at 950 units per hour to maintain a PTT between 60 and 80 secondary to atrial fibrillation that has been rate controlled with a beta-blocker. She was discharged on diltiazem 30 mg q.i.d. and a normal dosing of Nexium 40 mg p.o. q.d. while in-house. She was given Darvon and Codeine as needed for pain, and was prescribed Caltrate plus Vitamin D 600 mg, Maalox tablets, Magnesium oxide 400 mg, Multivitamin, Niferex 150 mg, and Lovenox 60 mg subcutaneously b.i.d. with a renal adjustment and NovoLog 15 units subcutaneously with breakfast and dinner. The patient was instructed to call Dr. Mccutchan office to coordinate her appointment for her valve repair in the next one to two weeks pending her surgeon's return and to call Dr. Doug Schlanger on March 2005 to discuss surgical plans and also to follow up. All her blood cultures should be followed up prior to her surgery and if any of her blood cultures become positive in the interim, a long course of antibiotic therapy should be started and surgery should be delayed at the discussion of the Cardiovascular Service. Her medications included Lasix 40 mg p.o. q.o.d. alternating with 80 mg p.o. Lasix q.o.d., Digoxin 0.125 mg q.o.d. alternating with 0.25 q.o.d., Lisinopril 20 mg p.o. q.d., Coumadin 6 mg p.o. q.o.d. alternating with 4 mg q.o.d., Omeprazole 20 mg b.i.d., Metformin 500 mg daily, Insulin 70/30 65 units q.a.m., 35 units q.p.m., Calcium 600 mg p.o. b.i.d., Magnesium 400 mg p.o. b.i.d., Multivitamin, Iron tablets, Actonel every Wednesday, Caltrate plus vitamin D 600 mg one tablet p.o. b.i.d., Maalox tablets quick dissolve, Magnesium oxide 400 mg p.o. b.i.d., Niferex 150 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d., Senokot three tablets p.o. b.i.d., Codeine 15 mg to 30 mg p.o. q.4h. p.r.n. pain. She was required to increase her dosage of Nexium secondary to GERD-like symptoms and was maintained on a stable regimen of NPH 60 units in the morning, NPH 30 units in the evening, and NovoLog of 15 units in the morning with breakfast and 15 at dinner with a sliding scale. She was also transitioned to Lovenox 60 mg b.i.d. with a renal adjustment and was sent to the ED for diuresis where she was given 60 mg of Lasix. | How much diltiazem does the patient take per day | {
"answer_end": [
795
],
"answer_start": [
751
],
"text": [
"She was discharged on diltiazem 30 mg q.i.d."
]
} |
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 ever had home meds. | {
"answer_end": [
1602
],
"answer_start": [
1513
],
"text": [
"and to continue stool softeners for constipation and resume all home meds upon discharge."
]
} |
Logan Czaplinski, an 833-08-42-8 patient, was admitted on 1/27/2001 and discharged on 5/18/2001 to his home with a prescription of ASA (Acetylsalicylic Acid) 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lasix (Furosemide) 80 MG PO BID, Ativan (Lorazepam) 1 MG PO BID PRN anxiety or insomnia, Lopressor (Metoprolol Tartrate) 12.5 MG PO BID, Thiamine (Thiamine HCl) 100 MG PO QD, Coumadin (Warfarin Sodium) 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), Insulin 70/30 (Human) 30 units SC BID, Imdur (Isosorbide Mononit.(SR)) 60 MG PO QD, KCL Slow Rel. 20 mEq x 1 PO BID, Allegra (Fexofenadine HCl) 60 MG PO QD, and Levofloxacin 250 MG PO QD Starting in AM (7/21). An override was added on 10/10/01 by Kent R. Kazee, MD with Potentially Serious Interactions: Aspirin & Warfarin, Simvastatin & Warfarin, and Levofloxacin & Warfarin. Food/Drug Interaction Instructions were also given. This 60-year-old male patient with ischemic CMP and AFib was started on Coumadin 5 weeks ago and was cardioverted via the AICD last Tuesday. He then developed SOB and fever, so he went to the local ED and was given Lasix and Rocephin. His WBC was elevated at 12.2 and he was sent to LMH where he had a low grade fever and required FM O2. He was treated empirically with Levofloxacin, diuresed, and assessed for underlying rhythm. His CXR showed interval improvement and his BCXs from LWMH were negative at 3 days. He was discharged on PO diuretics and a 14-day course of Levofloxacin, with ASA 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lopressor 12.5 MG PO BID, Thiamine 100 MG PO QD, Coumadin 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), and Ativan 1 MG PO BID PRN anxiety or insomnia. He should seek immediate medical attention if he develops chest pain, SOB, lightheadedness, fever, chills, palpitations, or falls. | Has the patient had previous digoxin | {
"answer_end": [
219
],
"answer_start": [
197
],
"text": [
"Digoxin 0.25 MG PO QD,"
]
} |
Mr. Almon is a 51 year old gentleman with history of insulin dependent diabetes mellitus and unstable angina who was doing yard work and experienced an episode of nausea and vomiting along with chest discomfort. His EKG was noted to have an old T wave inversion in lead 3 which was now upright and ST depressions that were normalizing, along with CKs of 974 and MB 24.3 and Troponin level of 1.77. He received aspirin 5 mg of intravenous Lopressor, Heparin drip and Adenosine MIBI. Cardiac catheterization revealed Right dominant system, no significant left main lesions identified, left anterior descending coronary artery with a discreet mid 65% lesion, distal 99% lesion and first diagonal coronary artery with a proximal discrete 70% lesion, left circumflex coronary artery with a distal after the second obtuse marginal discrete 60% lesion, supplying the second obtuse marginal. First marginal coronary artery had an ostial discrete 90% lesion and a second obtuse marginal had an ostial discrete 100% lesion. Right coronary artery had a mid discrete 95% lesion supplying the right posterior descending coronary artery. The patient underwent echocardiogram which revealed mild concentric left ventricular hypertrophy with normal cavity size and left ventricular systolic function mildly reduced with an estimated ejection fraction of 45%, severe hypokinesis of the basal and mid segments of the inferior wall and inferior septum, and severe hypokinesis of the posterior wall, apex and distal anterior wall. He underwent coronary artery bypass graft x 3 with a left internal mammary artery to left anterior descending artery, saphenous vein graft to the obtuse marginal coronary artery and saphenous vein graft to the intermediate coronary artery. Postoperatively, he was extubated on postoperative day number one and transferred to the step down unit, with a T.max of 99. He had serous drainage from the inferior aspect of his sternal incision. He was started on Keflex 500 mg four times a day for 10 days. Discharge medications included Enteric coated aspirin 325 mg once a day, ibuprofen 200 to 800 mg every 4 to 6 h p.r.n. pain, NPH Humulin insulin 44 units in the morning, 14 units in the evening, regular insulin 6 units twice a day, Niferex 150 mg twice a day, potassium chloride 20 mEq once a day, Zocor 40 mg once in the evening, Atenolol 50 mg once a day, Lisinopril 10 mg once a day, Keflex 500 mg four times a day for 10 days for his superficial sternal wound infection and torsemide 60 mg twice a day, and he was discharged to home in stable condition. | What is the patient's current dose does the patient take of her nph humulin insulin | {
"answer_end": [
2242
],
"answer_start": [
2181
],
"text": [
"14 units in the evening, regular insulin 6 units twice a day,"
]
} |
A 83 year old female with hereditary angioedema was admitted to the hospital with abdominal pain which was not relieved by Stanazolol, and she had diarrhea, nausea/vomiting, sweats, and decreased PO intake. She was given 6 units FFP with premedication of IV Benadryl on the first night of her hospitalization, Stanazolol 4 mg q4h overnight, which was changed to bid on second hospital day, Zantac, and Lovenox. The patient was maintained on Acetylsalicylic Acid 81 mg PO qd, Vit C 500 mg PO bid, Atenolol 75 mg PO qd, hold if sbp <100 or hr <60, Digoxin 0.125 mg PO qod (Sun, Tues, Thurs), Potentially serious interaction: Digoxin & Levothyroxine Sodium, Vit E 400 units PO qd, Pepcid 20 mg PO qd, Colace 100 mg PO bid PRN constipation, Senna Tablets 2 tab PO bid PRN constipation, Lasix 20 mg PO qd, Keflex 500 mg PO qid x 28 doses, and on order for Synthroid PO (ref. #66804792), Lasix PO (ref. #91042032), and Keflex PO (ref. #63524947). She was also continued on her home dose of Synthroid, Rhinocort (Budesonide Nasal Inhaler) 2 spray na bid, and Allegra (Fexofenadine HCl) 60 mg PO bid. She was discharged with instructions to follow up with allergy and to call her doctor if she develops fevers, worsening of her abdominal pain, or other concerning symptoms. Follow up appointments were made with Dr. Morrell and Dr. Guadagnolo or Dr. Yoes for 1-2 weeks. | Is there history of use of stanazolol | {
"answer_end": [
340
],
"answer_start": [
267
],
"text": [
"on the first night of her hospitalization, Stanazolol 4 mg q4h overnight,"
]
} |
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 | What medications have been previously used for prevention of glycemic control | {
"answer_end": [
2434
],
"answer_start": [
2379
],
"text": [
"Prandin and insulin sliding scale for glycemic control."
]
} |
Ms. Halnon is a 67-year-old female with multiple medical comorbidities and a past medical history significant for cardiac transplant in 1993, and hip replacement in July 2005, complicated by wound infection, and need for prolonged rehabilitation who presented from Port Medical Center to Ephma Mersources Ni Memorial Hospital with three days of progressive worsening shortness of breath. Upon admission, her mental status was borderline, but it improved with discontinuation of standing analgesic and decreasing of her clonazepam. A head CT showed no acute processes. She had a right upper arm cellulitis and urinary tract infection on screening urinalysis. She was anemic and was found to be vancomycin resistant Enterococcus positive, but repeated cultures demonstrated MRSA negative. For her heart failure, she was diuresed with IV and transitioned to oral torsemide and they entered discharge dose of torsemide 200 mg p.o. twice per day. She was given a five-day course of levofloxacin (used to address recurrent UTI) and then a two-day course of Ancef, her cellulitis was initially treated with levofloxacin and transitioned to Bactrim based on antibiogram sensitivities. A long-term Foley was placed for comfort with catheter in place. While on Bactrim for her UTI, her creatinine rose from 1.5 to 1.6, but cleared with this regimen. For her chronic anemia, the patient was continued on iron (which was increased to three times per day) and darbepoetin, folate was added. She was asymptomatic from her chronic anemia. She was given two units of packed red blood cells in March, 2005, and two more units on February, 2006. Her admission weight was 133 kg and her creatinine was 1.6. At discharge, she was hemodynamically stable, afebrile, and breathing comfortably on three liters of oxygen. Her discharge medications included Vitamin C 500 mg twice per day, Imuran 25 mg daily, PhosLo 667 mg three times per day, clonazepam 0.25 mg twice daily, iron sulfate 325 mg three times per day, folate 1 mg daily, Dilaudid 2 mg every six hours as needed for pain, lactulose 30 mL four times per day as needed for constipation, prednisone 5 mg every morning, Sarna topical every day apply to affected areas, multivitamin daily, Coumadin 2.5 mg daily, goal INR 2 to 3, zinc sulfate 220 mg daily, Ambien 5 mg before bed as needed for insomnia, torsemide 200 mg by mouth two times per day, cyclosporine 50 mg twice daily, Colace 100 mg twice daily, insulin NPH 14 units every evening, insulin NPH 46 units every morning, esomeprazole 20 mg once per day, DuoNeb 3/0.5 mg inhaled every six hours as needed for shortness of breath, Aranesp 50 mcg subcutaneously once per week, NovoLog sliding scale before meals, Lexapro 20 mg once per day, Maalox one to two tablets every six hours as needed for upset stomach, and Lipitor 20 mg once per day. Outstanding issues include following INR the goal of 2 to 3, following weight and clinical signs of volume overload, following up on loose stools for possible Clostridium difficile infection, and following clinical signs for evidence of urinary tract infection treating with antibiotics as necessary. | What is the current dose of the patient's coumadin | {
"answer_end": [
2246
],
"answer_start": [
2155
],
"text": [
"Sarna topical every day apply to affected areas, multivitamin daily, Coumadin 2.5 mg daily,"
]
} |
Faustino Decicco was admitted to the CAR service on 4/24/2006 and discharged on 11/30/2006 with a Full code status. The patient was treated for nausea with Reglan, and additionally had a UTI which was treated with empiric amox. She underwent TKR on 4/10 without cardiac complications and was sent to rehab until 5/22 when she was discharged home. The discharge medications included DUONEB (Albuterol and Ipratropium Nebulizer) 3/0.5 MG INH Q6H, Allopurinol 100 MG PO daily, Atenolol 25 MG PO daily, PULMICORT TURBUHALER (Budesonide Oral Inhaler) 1 puff INH BID, LASIX (Furosemide) 40 MG PO daily, ZOCOR (Simvastatin) 40 MG PO bedtime, Reglan (Metoclopramide HCl) 10 MG PO QID, RANITIDINE HCL 150 MG PO daily, Senna Tablets (Sennosides) 2 TAB PO BID PRN Constipation, Enteric Coated Aspirin (Aspirin Enteric Coated) 81 MG PO daily, on order for MULTIVITAMIN THERAPEUTIC PO (ref # 124703437) with potentially serious interaction: Simvastatin & Niacin, Vit. B-3 Reason for override: Starting Today August 10, 2006, and MULTIVITAMIN THERAPEUTIC (Therapeutic Multivitamin) 1 tab PO daily. She was discharged home on her home medicines including the Amoxicillin and Reglan, DUONEB (Albuterol and Ipratropium Nebulizer) 3/0.5 MG INH Q6H, Allopurinol 100 MG PO daily, Atenolol 25 MG PO daily, PULMICORT TURBUHALER (Budesonide Oral Inhaler) 1 puff INH BID, LASIX (Furosemide) 40 MG PO daily, ZOCOR (Simvastatin) 40 MG PO bedtime, Reglan (Metoclopramide HCl) 10 MG PO QID, RANITIDINE HCL 150 MG PO daily, Senna Tablets (Sennosides) 2 TAB PO BID PRN Constipation, Enteric Coated Aspirin (Aspirin Enteric Coated) 81 MG PO daily, on order for MULTIVITAMIN THERAPEUTIC PO (ref # 124703437) with potentially serious interaction: Simvastatin & Niacin, Vit. B-3 Reason for override: Starting Today August 10, 2006, and MULTIVITAMIN THERAPEUTIC (Therapeutic Multivitamin) 1 tab PO daily. VNA to remove staples from knee replacement on 0/28. F/u nausea, Cr, INR, HCT, chest pain sxs. | Is the patient currently or have they ever taken simvastatin | {
"answer_end": [
949
],
"answer_start": [
895
],
"text": [
"potentially serious interaction: Simvastatin & Niacin,"
]
} |
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. | What is her current dose of ibuprofen | {
"answer_end": [
1515
],
"answer_start": [
1479
],
"text": [
"IBUPROFEN 600-800 MG PO Q6H PRN Pain"
]
} |
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. | Is the patient currently or have they ever taken warfarin | {
"answer_end": [
1749
],
"answer_start": [
1682
],
"text": [
"POTENTIALLY SERIOUS INTERACTIONS between AMIODARONE HCL & WARFARIN,"
]
} |
A 65 year old African-American female with a history of chronic pancreatitis was admitted to the Staho Health 10 of November to 3 of May for her chronic pancreatitis and returned on the 24 of January with recurrent abdominal pain and symptoms consistent with her chronic pancreatitis. On admission, she had a low grade temperature of 100.2, was tachycardic with a heart rate of 131, respiratory rate 20, blood pressure 132/80. Abdominal exam was significant for decreased bowel sounds and abdominal tenderness in the midepigastric region with guarding. Laboratory data showed sodium 128, potassium 4.1, chloride 95, bicarb 26, BUN 23, creatinine 0.8, glucose 433, WBC 17.8, hematocrit 33, platelets 370, alk level of 434, T-bili was 0.6, D-bili was 0.2, lipase was 123, and amylase was 37. An ultrasound showed no gallstones and a 6 cm cyst in the region of the pancreatic head. EKG showed her to be in sinus tachycardia with the rate of 122. Her past medical history was significant for pancreatitis, asthma, insulin dependent diabetes mellitus, history of vascular necrosis of both hips, status post a total hip replacement on the right and left, known coronary artery disease, history of chronic obstructive pulmonary disease, history of GI bleed, status post a Nissen fundoplication with redo, hypertension, alpha thalassemia, history of congestive heart failure, and chronic low back pain secondary to spinal stenosis. Her medications included Metformin, Atrovent, Albuterol, Flovent, Elavil, Cisapride, Flexeril, Axid, NPH insulin, Cardizem CD, lisinopril, Lasix, magnesium oxide, Percocet, Premarin, Provera, Prilosec, Lipitor, Tums and multi-vitamins. She had allergies to Aspirin, Ibuprofen, meperidine, prednisone, penicillin, fophonomide, codeine, morphine, and was not a drinker or smoker. She had developed a urinary tract infection with yeast and was started on fluconazole, and was also begun on H. pylori therapy of Biaxin and bismuth. At the time of discharge, the patient was relatively pain-free, tolerating a p.o. diet, and afebrile and was discharged to the Triadnockum for rehabilitation on her usual medications plus the above-mentioned antibiotics, to complete a seven-day course, and will follow up in the Gug University in the next one to two weeks and will be followed by her primary care physician, Dr. Lorenzo. | Has this patient ever been prescribed nph insulin | {
"answer_end": [
1550
],
"answer_start": [
1498
],
"text": [
"Cisapride, Flexeril, Axid, NPH insulin, Cardizem CD,"
]
} |
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