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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 this patient ever tried lisinopril
|
{
"answer_end": [
1383
],
"answer_start": [
1335
],
"text": [
"Lisinopril 10 mg q. day, Pravachol 20 mg q. day,"
]
}
|
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o.
|
Has the patient ever been on insulin lente
|
{
"answer_end": [
960
],
"answer_start": [
887
],
"text": [
"ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s.,"
]
}
|
Mr. Kanaan is a 68-year-old gentleman with stage IV esophageal cancer who presented with progressive shortness of breath over the three days prior to admission and had a known ejection fraction of 20%. His medical regimen was maximized with an ACE inhibitor or statin and baby aspirin was started on him. He was admitted with diarrhea related to chemotherapy, pulmonary edema secondary to decompensated heart failure, and gout in his right great toe. He was diuresed with Lasix and torsemide in addition to his spironolactone dose with a goal of 1.5 liters a day and received Atrovent nebulizers to help with his shortness of breath, with the combination of dopamine, nesiritide, and Lasix drips being most effective. His medications included amiodarone, digoxin, colchicine, Atrovent, lisinopril, spironolactone, torsemide, Ativan, Zocor, and Prilosec, with instructions to follow up with his primary care doctor with DVT prophylaxis with Lovenox. He also received ferrous sulfate 325 mg daily, trazodone 50 mg at night, multivitamins one tablet daily, and simvastatin 80 mg at night. He was discharged home with oxygen to use overnight and when symptomatic.
|
How much spironolactone does the patient take per day
|
{
"answer_end": [
562
],
"answer_start": [
511
],
"text": [
"spironolactone dose with a goal of 1.5 liters a day"
]
}
|
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.
|
diuretic
|
{
"answer_end": [
886
],
"answer_start": [
823
],
"text": [
"and continued to have decrease urine output on maximal diuretic"
]
}
|
Ms. Fought is a 50-year-old female with a history of bipolar disorder, schizophrenia, obstructive sleep apnea, hypertension, and diabetes who presented with right knee swelling, redness, and pain and was admitted to the Emergency Department. She was given therapeutic doses of heparin because of the concern of pain, as well as IV fluids, Oxycodone 5 mg to 10 mg p.o. q.4h. p.r.n. pain, Tylenol 650 mg p.o. q.4h. p.r.n. pain, Ibuprofen 600 mg q.6h. p.r.n. pain, Klonopin 1 mg p.o. at bedtime, Levofloxacin 500 mg p.o. daily for six days after the day of discharge, and NSAIDs, and was prescribed Lisinopril 10 mg daily, Lipitor 40 mg daily, Klonopin, MetroGel p.o. at bedtime, Lithium 900 mg at bedtime, Acebutolol 200 mg daily, and Risperdal 0.5 mg at bedtime, with no known drug allergies. She responded well to normal saline fluid boluses for a total of 3 liters over her hospital course, and was treated with Unasyn and vancomycin, and then switched to levofloxacin, with six more days after discharge from the hospital. Her bradycardia was resolved either over beta blockade or lithium toxicity, for which her beta-blocker was held and her lithium was also held, resulting in an improved heart rate in the 50s and 60s. Upon discharge, she was given instructions to draw blood for lithium level checks daily until it is below 0.5, at which time, she should be restarted on lithium 300 mg p.o. at bedtime, and to follow up with her primary care physician, Dr. Aurelio Gilberto Hencheck at Li County Hospital.
|
Is there history of use of levofloxacin.
|
{
"answer_end": [
564
],
"answer_start": [
493
],
"text": [
"Levofloxacin 500 mg p.o. daily for six days after the day of discharge,"
]
}
|
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage.
|
has there been a prior lipitor
|
{
"answer_end": [
514
],
"answer_start": [
488
],
"text": [
"Avapro, Lipitor, Decadron,"
]
}
|
Patient BEBEE , MITCHEL 900-43-64-1 was admitted on 9/12/2005 with atypical chest pain. The patient had a history of hyperlipidemia, HTN, and hypothyroidism, and reported a 4-hour burning epigastric pain that resolved with opiates in the ED. The EKG showed no changes and the cardiac markers were negative x3. Adenosine MIBI was negative. The patient was discharged on 9/29/05 and instructed to take SYNTHROID ( LEVOTHYROXINE SODIUM ) 100 MCG PO QD , NEXIUM ( ESOMEPRAZOLE ) 40 MG PO QD, LIPITOR ( ATORVASTATIN ) 10 MG PO QD and TOPROL XL ( METOPROLOL ( SUST. REL. ) ) 50 MG PO QD consistently with meals or on empty stomach. The patient was also instructed to resume regular exercise and was given a follow up appointment with Dr Decambra in 1-2 weeks. The patient has allergies to sulfa, cephalosporins, and IV contrast. An abdominal CT in the ED showed a 3 cm mesenteric lymph node and the patient should have a repeat CT in 3 months. The stress test of the heart was negative and the patient was discharged in stable condition.
|
Is the patient currently or have they ever taken toprol xl ( metoprolol ( sust. rel. ) )
|
{
"answer_end": [
580
],
"answer_start": [
529
],
"text": [
"TOPROL XL ( METOPROLOL ( SUST. REL. ) ) 50 MG PO QD"
]
}
|
Mr. Royce Meidlinger is a 78-year-old male who was admitted on 11/12/05 with ADMISSION MEDICATIONS including Atenolol 25 mg daily, allopurinol 300 mg daily, and Flomax 0.8 mg daily. Cardiovascularly, he was on aspirin and had a pacemaker for sick sinus and was saturating well on 2 liters of oxygen delivered by Dobbhoff. Respiratorily, white count at preop baseline was afebrile completing 21 day course of linezolid for EC bacteremia and chest x-ray improved after adding low-dose Lasix. Renally, there was a postoperative increase in creatinine requiring dopamine 2 mcg, continued high chest tube output and an official echo report showed moderate TR, with no changes from prior echos. Hematology was treated with aspirin and anticoagulation and he had left upper extremity DVT as well, was started on argatroban, PTT to be therapeutic, with argatroban dose increased from 0.1 to 0.2, bridging to Coumadin, and argatroban dose reduced to maintain PTT of 50. He had profuse GI bleeding requiring 3 units of packed red blood cells, 2 units packed red blood cells with improvement in hematocrit, NG-tube aspiration with melena, and was HIT positive with worsening clinical syndrome. Foley was put in place with Lasix for reduced urine output and left hand demarcated with argatroban dose increased from 0.1 to 0.2, bridging to Coumadin, restarting Coumadin, postop day #51, patient went to OR with plastics for toe finger amputations/left hand debridement, holding tube feeds, was on triple antibiotic therapy for sputum/blood culture, and rehabilitation when restarting Coumadin. Postop day #54
|
Is there a mention of of flomax usage/prescription in the record
|
{
"answer_end": [
181
],
"answer_start": [
161
],
"text": [
"Flomax 0.8 mg daily."
]
}
|
This 64-year-old male with a history of coronary artery disease, CHF, EF of 15%, status post AVR, and NSTEMI initially presented to outside hospital with chief complaint of shortness of breath and was found to have a BNP of 747 as well as a troponin I of 0.43. He was diuresed, started on Carvedilol and improved, and placed on a heparin drip. His medications on admission included Aspirin 81, Lisinopril 20, Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d., Nystatin 500 b.i.d., Paxil 20 daily, Glipizide 10 daily, Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily, heparin drip and Spironolactone. During his hospital stay, he was continued on Aspirin, Plavix, beta-blocker and ACE inhibitor, which were titrated to effect, started on a statin and continued on Niaspan, and maintained on a nicotine patch. He was also prescribed Spironolactone 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, and Coumadin 5 mg p.o. at night. The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics, which were discontinued on admission and was encouraged to stop smoking. He had runs of ectopy and SVT, so was placed on a heparin drip. Left heart cath revealed wall defect consistent with a right coronary artery infarct and the patient was continued on Spironolactone. He was discharged in a stable condition on Aspirin 325 p.o. daily, Lisinopril 4 mg p.o. daily, Nicotine patch 14 mg per day topical, Spironolactone 25 mg p.o. daily, Paxil 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, Carvedilol 12.5 mg p.o. twice daily, Plavix 75 mg daily, Gemfibrozil 900 mg p.o. twice daily and Coumadin 5 mg p.o. at night, with instructions to follow up with PCP and Cardiology as well as EP, to check his daily weights and report any increases to his PCP, and to arrange to have his INR drawn on 6/21/06 and follow-up INRs to be drawn every seven days.
|
Has the patient had previous niaspan
|
{
"answer_end": [
848
],
"answer_start": [
767
],
"text": [
"started on a statin and continued on Niaspan, and maintained on a nicotine patch."
]
}
|
Mr. Slunaker is a 56-year-old gentleman who underwent coronary artery bypass grafting x4 and was discharged to home in stable condition on 10/20/06. He presented to see Dr. Emory Bebeau in clinic with a warm and swollen left lower leg with redness and was placed on levofloxacin and vancomycin and had him admitted for left lower leg cellulitis. On admission, he was taking Toprol 25 mg daily, diltiazem 30 mg t.i.d., aspirin 325 mg daily, Lasix 40 mg daily, atorvastatin 40 mg daily, Tricor 145 mg daily, Zetia 10 mg daily, metformin 500 mg daily and potassium chloride slow release 20 mEq daily. Infectious disease was consulted and recommended discontinuing the vancomycin and levofloxacin and changing to Ancef 1 gm IV q.8h. and monitoring his wound. The patient remained afebrile and his white count trended down and leg wound improved on exam. On the day of discharge, he was evaluated by Dr. Manvelyan and cleared for discharge to home with Augmentin 875/125 mg b.i.d. for a total of 10 days, enteric-coated aspirin 325 mg daily, Lipitor 40 mg daily, diltiazem 30 mg t.i.d., Zetia 10 mg daily, Tricor 145 mg nightly, Diflucan 200 mg daily for one dose for a penile yeast infection, due to antibiotic use, Metformin 500 mg q.p.m., Toprol-XL 25 mg daily and oxycodone 5-10 mg q.4h. p.r.n. pain. He was instructed to monitor his leg wound and call if he had any increased weight, temperature greater than 101 degrees, any drainage from the wound, redness, swelling or change of any kind in his leg wound. He was cleared by Infectious Disease Service and discharged to home in stable condition and will follow up with Dr. Noah Schaffhauser on 5/7/06 at 1 o'clock, Dr. Aaron Phung in three-four days, his primary care physician, and his cardiologist, Dr. Jonathon Sopata in one to two weeks.
|
has the patient had potassium chloride slow release
|
{
"answer_end": [
597
],
"answer_start": [
552
],
"text": [
"potassium chloride slow release 20 mEq daily."
]
}
|
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 the patient ever had aricept ( donepezil hcl )
|
{
"answer_end": [
507
],
"answer_start": [
471
],
"text": [
"ARICEPT (Donepezil HCL) 10 MG PO QPM"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
Has this patient ever been prescribed lipitor
|
{
"answer_end": [
708
],
"answer_start": [
625
],
"text": [
"Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd,"
]
}
|
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
|
What medications have been previously used for the treatment of her known diabetes.
|
{
"answer_end": [
1861
],
"answer_start": [
1825
],
"text": [
"NPH 20 units for her known diabetes,"
]
}
|
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 the patient ever tried for alcohol use. prevention
|
{
"answer_end": [
727
],
"answer_start": [
642
],
"text": [
"he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n."
]
}
|
Ms. Leezer is a 50 year-old woman with a history of end stage renal disease, status post renal transplant, and a history of coronary artery disease, status post coronary artery bypass grafting. She had an episode of chest pain which was relieved by Nitroglycerin and passed out while saying goodbye to her husband, as well as several episodes of skipped heart beats during and after which she feels short of breath, and slurred speech for a few minutes. On admission her temperature was 98.8, pulse 96, blood pressure 120/70, and respirations 18. During her stay she was given a 250 cc fluid bolus, transfused two units of blood and her hematocrit went up to 31. Laboratory data revealed a sodium of 137, potassium 4.4, chloride 104, bicarbonate 15, BUN 86, creatinine 3.1, ALT 6, AST 11, alkaline phosphatase 44, bilirubin total 0.4, direct bilirubin 0.1, calcium 9.5, cholesterol 360, and HDL 40. An exercise tolerance test MIBI was performed, which was negative for ischemia, and the patient's ejection fraction was approximated to be 69%. Carotid noninvasives revealed moderate internal carotid plaque on the right and mild stenosis of the other arteries. An echocardiogram revealed concentric left ventricular hypertrophy with an ejection fraction of 65%. The patient was taken to Electrophysiology Study which revealed nonsustained ventricular tachycardia with possible right ventricular outflow tract origin. It was hoped that she could be maintained on Lopressor and Verapamil; however, her blood pressure did not tolerate the medication, so she was already on Atenolol for Beta blockade and Verapamil was tried. Her discharge medications included Aspirin 81 mg p.o. q. day, Vitamin C 100 mg p.o. q. day x14 days, Epogen 2,000 subcu q. week, Lasix 60 mg p.o. q. day, Gemfibrozil 300 mg p.o. b.i.d., Lisinopril 5 mg p.o. q. day, Prilosec 20 mg p.o. q. day, Prednisone 5 mg p.o. on even days, 10 mg p.o. on odd days, MVI with minerals one tablet p.o. q. day, Thiamine 50 mg p.o. b.i.d., Bicitra 15 ml p.o. b.i.d., Nephrocaps one tablet p.o. q. day, Cyclosporine 125 mg p.o. in the morning and 100 mg p.o. in the afternoon, Insulin sliding scale, Cellcept 1,000 mg p.o. b.i.d., and Prempro 0.625/0.25 mg p.o. q. day. Her triglycerides were checked during the hospitalization and found to be very high in the 1,500 range, so she was taken off Simvastatin and started on Gemfibrozil. She was discharged in stable condition the next day.
|
Was the patient ever given nitroglycerin. for chest pain
|
{
"answer_end": [
262
],
"answer_start": [
205
],
"text": [
"episode of chest pain which was relieved by Nitroglycerin"
]
}
|
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 types of medications have been tried for her urinary tract infection management
|
{
"answer_end": [
1129
],
"answer_start": [
1058
],
"text": [
"her cellulitis was initially treated with levofloxacin and transitioned"
]
}
|
Mr. Klaja is an 81-year-old gentleman who presented with abdominal pain and diarrhea, and an abdominal CT revealed an infectious inflammatory bowel process. Stool samples were sent for C. diff toxin and assay, all were negative, while stool cultures did not grow anything out. Empiric treatment with p.o. vancomycin was started, and the patient's abdominal pain resolved and he was afebrile by discharge. A flexible sigmoidoscopy showed colitis consistent with inflammatory etiology, and the patient was discharged with a presumed C. diff colitis diagnosis on a 2-week course of vancomycin. The patient had a DVT followed by bacteremia with multi-resistant Klebsiella pneumoniae, treated with meropenem for 14 days with the course. The patient had no evidence of acute coronary syndrome on admission, and his coronary artery disease, CHF, and chronic kidney disease were managed with MEDICATIONS: aspirin 81 mg, Plavix 75 mg, Coumadin 5 mg, digoxin 0.125 mg, Lasix 49 mg daily, lisinopril 10 mg daily, Lopressor 25 mg b.i.d., Zocor 80 mg daily, Flomax 0.4 mg daily and Flovent 110 mcg b.i.d., lactobacillus p.o. for probiotics and patient also had flex sig 2-week course p.o. vancomycin alone. He was given gentle hydration therapy with 2 liters of IV fluids, and restarted on Lasix 40 mg p.o. daily for diuresis. He was also discharged on a course of lactobacillus p.o. for probiotics, with DISCHARGE MEDICATIONS: Included aspirin 81 mg p.o. daily, Plavix 75 mg p.o. daily, digoxin 0.125 mg p.o. daily, Nexium 20 mg p.o. daily, lactobacillus 2 tabs p.o. t.i.d., metoprolol 25 mg p.o. b.i.d., simvastatin 80 mg p.o. at bed time, Flomax 0.4 mg p.o. every evening, vancomycin 250 mg p.o. every 6 hours x8 days at supertherapeutic, Coumadin 6 mg p.o. daily, Flovent 110 mcg inhale b.i.d., Lasix 40 mg p.o. daily, his daily dose at home.
|
has there been a prior digoxin
|
{
"answer_end": [
911
],
"answer_start": [
884
],
"text": [
"MEDICATIONS: aspirin 81 mg,"
]
}
|
The patient had continued to remain stable from an ischemia standpoint and a beta-blocker was added back to his regimen and was titrated to a dose of Lopressor 12.5 mg p.o. t.i.d. He continues on aspirin and statin, and he also continues on Isordil 20 mg p.o. t.i.d. and hydralazine 50 mg p.o. t.i.d. for after load reduction, as well as digoxin at 0.125 mg p.o. q.o.d. The patient was aggressively diuresed with intravenous Lasix and Zaroxolyn followed by conversion to oral diuresis with torsemide at the dose of 100 mg p.o. q.d. He was also found to have atrial clot on transesophageal echocardiogram and thus was started on a heparin drip and transitioned on Coumadin, but after a discussion with the CHF Team, the decision was made not to continue Coumadin anticoagulation and instead he was given aspirin and Plavix at full doses. The patient's medication regimen also includes Colace 100 mg p.o. b.i.d., Folate 1 mg p.o. q.d., Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough, Simethicone 80 mg p.o. q.i.d. p.r.n. upset stomach, Multivitamin one tab p.o. q.d., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Tessalon 100 mg p.o. t.i.d. p.r.n. cough, Lipitor 80 mg p.o. q.d., Plavix 75 mg p.o. q.d., Lantus 5 units subcu q.p.m., NovoLog 3 units subcu a.c. and NovoLog sliding scale. The patient is on ACE inhibitor and was restarted on a low-dose beta-blocker at 12.5 mg p.o. t.i.d. as well as his insulin regimen can be adjusted as an outpatient and possibly oral diabetes medications restarted. He is to be discharged to the Com Medical Center for further rehabilitation, with follow-up appointments with Dr. Kyle Yandle in the T Las on 2/28/05 at 08:30 a.m., Dr. Clyde Chatampaya of Elmert Hospital Cardiology 9/26/05 and Raymond Banaag of TRISTONTERN MEDICAL CENTER PCP on 10/3/05 at 01:50 p.m. His sister, Alexis Fernendez, is his health care proxy and is providing substantial social support.
|
Was the patient ever prescribed robitussin a-c
|
{
"answer_end": [
978
],
"answer_start": [
934
],
"text": [
"Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough,"
]
}
|
Patient Damion Prehn, a 60 year old male with coronary artery disease, hypertension, and hyperlipidemia, was admitted with increasing shortness of breath and intermediate MIBI as an outpatient in the setting of significant deconditioning and multiple cardiac risk factors. In the ED, his temperature was 98.6, his pulse was 70, his blood pressure was 141/69, and his saturation was 94% on room air. He was given ASA and Keflex for LE cellulitis, and his cardiac markers were negative. A cath revealed Subtotal RCA occlusion, 80% OM, and 50% mid LAD, and Cypher stents were placed in mid RCA to os and wedge elevated. EF 45% on stress echo and monitoring revealed 2 episodes of NSVT post-PCI. He was started on Atenolol 125 mg PO daily, Lipitor (Atorvastatin) 80 mg PO daily, Keflex (Cephalexin) 500 mg PO QID, Plavix (Clopidogrel) 75 mg PO daily, Enteric Coated ASA 325 mg PO daily, Lasix (Furosemide) 80 mg PO BID, Potassium Chloride Slow Rel. (KCL Slow Release) 10 MEQ PO daily, LISINOPRIL 5 MG PO DAILY, MICONAZOLE NITRATE 2% CREAM TP BID, MICONAZOLE NITRATE 2% POWDER TOPICAL TP BID, NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 0.5 GM PO QPM with instructions to take aspirin 30 minutes before-hand to prevent facial flushing. Alerts were overridden due to SERIOUS INTERACTION: MICONAZOLE NITRATE & ATORVASTATIN CALCIUM, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM, POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & MICONAZOLE NITRATE, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 and POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL. He was discharged on 9/23/06 with code status full code and disposition home, a diet of house/low chol/low sat. fat, and instructions to measure weight daily and resume regular exercise. Follow up appointments were scheduled with Dr. Weakland, Primary Care 1-2 weeks and Dr. Trouser, Cardiology 571-491-1951 Please call in 1-2 days if you do not hear from the office. You must be seen in 2-4 weeks. Allergy is to Shellfish. ASA/Plavix were continued at current doses x 1 year, increased lasix from 40 mg PO daily to 80 mg PO BID, increased b-blocker, continued norvasc, and stopped isordil. Low dose potassium 10mEq was started as increased lasix, and lisinopril 5mg PO daily was started to prevent facial flushing. Patient was instructed to take aspirin 30 minutes before hand to prevent serious interaction between miconazole nitrate and atorvastatin calcium/simvastatin, and potassium chloride immediate rel. PO was ordered. Instructions were given to continue toe cream, check lytes in 2 days, and come to the ER if any concerning symptoms such as trouble breathing, chest pain, or leg swelling. Do NOT discontinue these medications without speaking to your doctor.
|
Is the patient currently or have they ever taken potassium chloride slow rel. ( kcl slow release )
|
{
"answer_end": [
980
],
"answer_start": [
916
],
"text": [
"Potassium Chloride Slow Rel. (KCL Slow Release) 10 MEQ PO daily,"
]
}
|
Patient Mickey Corkill was admitted to the hospital on 5/29/2004 for dizziness and discharged on 7/17/2004. During this time, the patient was given ACETYLSALICYLIC ACID 81 MG PO QD Starting STAT ( 0/17 ), AMIODARONE 200 MG PO QD, DIGOXIN 0.125 MG PO QD, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, LASIX ( FUROSEMIDE ) 120 MG PO BID, NPH HUMULIN INSULIN ( INSULIN NPH HUMAN ) 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ) 30 MILLILITERS PO QD PRN Constipation, COUMADIN ( WARFARIN SODIUM ) 2 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, NORVASC ( AMLODIPINE ) 10 MG PO QD HOLD IF: SBP < 95, IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR ( LOSARTAN ) 100 MG PO QHS Starting STAT ( 4/13 ), PLAVIX ( CLOPIDOGREL ) 75 MG PO QD Starting STAT ( 0/17 ), NEXIUM ( ESOMEPRAZOLE ) 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, Sliding Scale ( subcutaneously ) SC AC+HS, and HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. Due to the potential for serious interactions between WARFARIN and ASPIRIN, WARFARIN and AMIODARONE HCL, DIGOXIN and AMIODARONE HCL, and SIMVASTATIN and WARFARIN, overrides were added on 8/6/04 and 9/23/04 by various physicians, with the MDs being aware that the patient was already on the regimen at home. The patient was also advised to avoid high Vitamin-K containing foods and to avoid grapefruit unless the MD instructed otherwise. The patient's BB was held while in house because of worry about bradyarrhythmia and hypotension. The patient was also continued on home insulin regimen with coverage with insulin sliding scale, and was found to have a TSH of 158 FT4 1.8, FT3 56. The patient was also started on synthroid to be f/u for hypothyroidism and given prophylaxis with Nexium. Treatment included CV, NEURO, ENDO, and Prophylaxis, with the patient to follow-up with various doctors for management of CHF/BP, potential neurovascular etiology of symptoms, and hypothyroidism. The patient was anticoagulated with ACETYLSALICYLIC ACID 81 MG PO QD, AMIODARONE 200 MG PO QD, WARFARIN 2 MG PO QPM, COLACE 100 MG PO BID, LASIX 120 MG PO BID, NPH HUMULIN INSULIN 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA 30 MILLILITERS PO QD PRN Constipation, COUMADIN 2 MG PO QPM, NORVASC 10 MG PO QD HOLD IF: SBP < 95, IMDUR 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR 100 MG PO QHS, PLAVIX 75 MG PO QD, NEXIUM 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, and SIMVASTATIN 80 MG PO QHS HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. The patient was discussed with the cardiologist, and Coreg was held prior to admit for low BP's, with the plan to d/c pt off Coreg and defer to Dr. Doniel for reinstitution of beta blockade. Neuro exam was normal with no focal signs, and no signs of cerebellar dysfunction. The patient was also started on synthroid to be f/u with endocrine for management of hypothyroidism.
|
What is her current dose of nexium ( esomeprazole )
|
{
"answer_end": [
886
],
"answer_start": [
850
],
"text": [
"NEXIUM ( ESOMEPRAZOLE ) 20 MG PO QD,"
]
}
|
A 56-year-old morbidly obese female with abdominal skin laxity due to massive weight loss after gastric bypass was admitted to plastics for panniculectomy. The patient tolerated the procedure without difficulty and the post-operative period has been uneventful. At discharge, the patient is afebrile with stable vitals, taking PO's/voiding q shift and has ambulated independently with some difficulty given body habitus. Pain has been well managed and incisions are clean, dry, and intact. JP's with moderate serosanguinous output remain in place. The patient was discharged to rehab in a stable condition, with instructions to continue antibiotics as long as drains are in place, change drain sponges daily, strip drains twice daily, sponge baths only while drains are in place, walking as tolerated, no lifting more than 10 pounds, no jogging, swimming, or aerobics for 4-6 weeks, and to monitor/return for signs of infection. Medications prescribed include TYLENOL (Acetaminophen) 1000 mg PO Q6H, KEFLEX (Cephalexin) 500 mg PO QID, COLACE (Docusate Sodium) 100 mg PO BID, PEPCID (Famotidine) 20 mg PO BID, DILAUDID (Hydromorphone HCL) 2-4 mg PO Q4H PRN Pain, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC Q4H Low Scale, LEVOTHYROXINE SODIUM 75 mcg PO daily, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MILK OF MAGNESIA (Magnesium Hydroxide) 30 milliliters PO daily PRN Constipation, METOCLOPRAMIDE HCL 10 mg IV Q8H PRN Nausea, QUINAPRIL 20 mg PO daily, SIMETHICONE 40 mg PO QID PRN Upset Stomach, Other:gas, and STYKER PAIN PUMP (Bupivacaine 0.5%) 400 milliliters IV Q24H Instructions: Rate = 4ml/hr. The patient has a probable allergy to Morphine and Code Status is Full Code.
|
has there been a prior tylenol ( acetaminophen )
|
{
"answer_end": [
999
],
"answer_start": [
960
],
"text": [
"TYLENOL (Acetaminophen) 1000 mg PO Q6H,"
]
}
|
Stansbury Ellsworth, a 59-year-old female with NIDDM, GERD, HTN, Depression, and known CAD s/p circumflex stent 2002, was admitted with atypical chest pain. Her EKG showed NSR 79 bpm, normal axis and intervals, with 1 mm ST segment depression V3-V5, and inverted Ts in V3-V5. Her CXR was negative for effusions, infiltrates, edema, and normal bony structures. A Mibi on 10/22 showed small perfusion defect without reversibility. Her esophagitis responded quickly to KBL and DIFLUCAN with her tolerating PO on AM of discharge. She was prescribed CLONAZEPAM 0.5 MG PO QD, LISINOPRIL 5 MG PO QD, POTASSIUM CHLORIDE IV, POTASSIUM CHLORIDE PO, MOM (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO QD, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, PROTONIX (PANTOPRAZOLE) 40 MG PO QD, LIPITOR (ATORVASTATIN) 20 MG PO QHS, ATENOLOL 25 MG PO QD, ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, REMERON (MIRAZAPINE) 15 MG PO QHS, CELEXA (CITALOPRAM) 20 MG PO QD, METFORMIN 500 MG PO BID, DIFLUCAN (FLUCONAZOLE) 100 MG PO QD X 12 doses, and KCL IMMEDIATE RELEASE PO. Overrides were added for DIFLUCAN PO (ref #62332050) and KCL IMMEDIATE RELEASE PO (ref # 57130577) due to POTENTIALLY SERIOUS INTERACTIONS: CLONAZEPAM & FLUCONAZOLE and LISINOPRIL & POTASSIUM CHLORIDE, respectively. She was to continue with remeron, celexa, and clonazepam, and was prescribed MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and MOM (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO QD Starting Today (9/4) PRN Constipation, Upset Stomach. She will complete two-week course of FLUCONAZOLE, with consideration of an outpatient EGD if symptoms do not improve with treatment. She was discharged in stable condition.
|
diflucan.
|
{
"answer_end": [
525
],
"answer_start": [
429
],
"text": [
"Her esophagitis responded quickly to KBL and DIFLUCAN with her tolerating PO on AM of discharge."
]
}
|
The patient is a 71-year-old male with a history of nonischemic dilated cardiomyopathy, diabetes, obstructive sleep apnea, obesity hypoventilation syndrome, and atrial flutter status post ablation. He presented with shortness of breath and a witnessed apneic episode with loss of consciousness and cyanosis. In the Centsshealt Careman Inerist Medical Center Emergency Department, he was found to be saturating 91% on room air and 99% on a nonrebreather with a pH of 7.31 and a PCO2 of 55; he was tried on BiPAP without improvement in either PCO2 or PO2. He was admitted to the CCU with CHF/apnea/sinus arrest and had a history of having stopped his Lasix dose one week prior. He was initially treated with x1 , Solu-Medrol , and DuoNebs in the ED, and ultimately treated with diuresis and a pacemaker placement. On admission, he was maintained on captopril, which was up titrated to 25 mg t.i.d. (held at one point due to the rise in the creatinine), titrated up on metoprolol to 25 mg b.i.d., antibiotics, Allopurinol 100 mg p.o. daily, Iron, Lisinopril, Toprol-XL, Coumadin (discontinued on 2/4/05), Albuterol inhaler p.r.n., Aspirin, Flomax, Hytrin, Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Flomax 0.4 mg p.o. daily, Nexium 20 mg p.o. daily, Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05, Lasix 40 mg p.o. daily, and Regular Insulin sliding scale subcutaneous q.a.c. He was followed by the Electrophysiology Service and had sinus arrest of 8-9 seconds in the setting of apnea in the CCU, and 4 seconds in the setting of apnea on the floor. He underwent pacemaker placement through cephalic veins, and was started on antibiotics following his pacemaker placement, which included cefazolin while in-house, followed by Keflex, and he was expected to stay on Keflex for four days. He was discharged with medications including Albuterol inhaler two puffs inhaled q.i.d. p.r.n. wheezing, Allopurinol 100 mg p.o. daily, Captopril 25 mg p.o. t.i.d., Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Lasix 40 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Regular Insulin sliding scale subcutaneous q.a.c., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05., Flomax 0.4 mg p.o. daily, and Nexium 20 mg p.o. daily.
|
Has patient ever been prescribed allopurinol
|
{
"answer_end": [
1037
],
"answer_start": [
1007
],
"text": [
"Allopurinol 100 mg p.o. 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 medications, if any, has the patient tried for pain in the past
|
{
"answer_end": [
761
],
"answer_start": [
699
],
"text": [
"with MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain,"
]
}
|
This 70-year-old woman with no known CAD, cardiac RF: HTN, DM, hyperchol., current tob., H/O PAF on no anticoag 2/2 distant h/o LGIB, a/w palpitations followed by 10 hrs of chest pain was admitted on 1/10/2001 and treated medically with lovenox/integrilin (refused cath) for NSTE MI. In the ED, pain was relieved with NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 and SLNG, and 2" NTP. EKG with TWflattening v5-6 but no ST elevations, and CK160, TnI 0.3. During her stay, she was on heparin, integrelin for NSTE MI, ASA, BB, ACEI, statin, nexium, colace, and levofloxacin for UTI, and lovenox for DVT proph. Her blood pressure was titrated to 130-160 and HCTZ was added for better control because her HR was in the 50's, and a repeat echo was done to check for any changes in function. Upon discharge, she will be on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, MICRONASE (GLYBURIDE) 5 MG PO QD, HCTZ (HYDROCHLOROTHIAZIDE) 25 MG PO QD, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3, ZOCOR (SIMVASTATIN) 20 MG PO QHS, LEVOFLOXACIN 250 MG PO QD X 4 Days, ZESTRIL (LISINOPRIL) 20 MG PO QD, ATENOLOL 50 MG PO QD Food/Drug Interaction Instruction, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, and POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, POTENTIALLY SERIOUS INTERACTION: HYDROCHLOROTHIAZIDE & OMEPRAZOLE, and SLNG PRN. She was also instructed to take atenolol consistently with meals or on empty stomach and to avoid grapefruit unless MD instructs otherwise. Follow up appointments were scheduled with Dr. Truman Thro 1-2 wks, Dr. Stevie Gilani, cardiology, Mon, 1/2/02 1:00 pm, and Bock 0/12/02.
|
Has this patient ever been on hydrochlorothiazide
|
{
"answer_end": [
1318
],
"answer_start": [
1285
],
"text": [
"HYDROCHLOROTHIAZIDE & OMEPRAZOLE,"
]
}
|
The patient is a 26-year-old female with a past medical history significant for Hodgkin's lymphoma, splenectomy, asthma, and history of tobacco use, who presented to our service with symptoms of congestive heart failure. She underwent an elective mitral valvuloplasty on November, 2003, with size 26 Cosgrove-Edwards ring and vegectomy, where epinephrine was used to maintain proper pressure and subsequently weaned off. On postoperative day #1, diuresis was increased and a low dose beta blocker was started, which she tolerated well. Baby aspirin and Neurontin 300 mg q.d. were also begun. The patient was discharged to home with VNA assistance with follow up recommendations and medications including enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d. x 7 days, Lasix 60 mg p.o. q.d., ibuprofen 800 mg p.o. q.8h. p.r.n. pain, Lopressor 25 mg p.o. t.i.d., Niferex 150 mg p.o. b.i.d., Atrovent nebulizer 0.5 mg nebulized q.i.d., Neurontin 300 mg p.o. q.d., K-Dur 30 mEq p.o. q.d. to be discontinued or decreased if Lasix dose is changed, and Flovent 44 mcg/inh b.i.d. The patient was also consulted with the Department of Neurology for persistent numbness and tingling of the left lower extremity, for which Neurontin 300 mg q.d. was prescribed. With aggressive diuresis, the patient was able to regain her postoperative weight and by the day of discharge was 1.7 kilograms below her preoperative weight. The patient is anticipated to return to her full preoperative level of independent functioning with continued cardiovascular rehabilitation and VNA assistance.
|
What is the dosage of lopressor
|
{
"answer_end": [
872
],
"answer_start": [
803
],
"text": [
"ibuprofen 800 mg p.o. q.8h. p.r.n. pain, Lopressor 25 mg p.o. t.i.d.,"
]
}
|
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.
|
Did the patient receive percocet for pain
|
{
"answer_end": [
1303
],
"answer_start": [
1245
],
"text": [
"constipation, Percocet 1-2 tablets p.o. q.4h. p.r.n. pain,"
]
}
|
A 45-year-old man with a history of familial cardiomyopathy and status post cardiac transplant in 2002, and chronic renal insufficiency presented with greater than two weeks of polyuria, polydipsia, blurry vision, muscle cramps, and myalgias and reported approximately a 15-pound weight loss over three weeks with decrease in usual lower extremity edema. On admission, notable for a blood glucose of 1064, creatinine 2.2 from a baseline of 1.8, sodium 130, potassium 4.9. Endocrine service was consulted and the patient was controlled with a combination regimen of Lantus, Novolog q. a.c., combined with a Novolog sliding scale. The patient was discharged with followup with Napoleon Mettee, the diabetic teaching nurse and with Dr. Jonson in the diabetes clinic and with VNA services to assist with home medications. The patient had mild acute gout flare during admission for which he was started on colchicine. The patient was discharged with medications including Calcium carbonate 1250 mg t.i.d., Cartia XT 300 mg daily, CellCept 1500 mg b.i.d., colchicine 0.6 mg daily p.r.n., Neoral 150 mg b.i.d., folate 1 mg daily, K-dur 20 mg daily, magnesium oxide 400 mg b.i.d., methotrexate 2.5 mg daily, Pravastatin 20 mg daily, prednisone 7 mg daily, Rocaltrol 0.25 mg daily, Synthroid 150 mcg daily, Torsemide 40 mg daily, Vitamin C, Vitamin E, and cyclosporin 150 mg b.i.d., Vitamin C 500 mg b.i.d., Rocaltrol 0.25 mcg daily, calcium carbonate 500 mg t.i.d., colchicine 0.3 mg p.o. b.i.d., cyclosporin 150 mg b.i.d., folic acid 1 mg daily, Synthroid 150 mcg daily, magnesium oxide 420 mg b.i.d., prednisone 7.5 mg q.a.m., Vitamin E 400 units daily, Pravachol 20 mg at night, Cartia XT that is diltiazem extended release 300 mg daily, CellCept 1500 mg b.i.d., Lantus insulin (Glargine) 40 units subcutaneous q.a.m., Novolog 12 units before breakfast, Novolog 12 units before lunch, Novolog 14 units before dinner, and Novolog sliding scale q. a.c. The patient demonstrated proper understanding of blood glucose testing and insulin administration prior to discharge.
|
has there been a prior colchicine.
|
{
"answer_end": [
912
],
"answer_start": [
883
],
"text": [
"he was started on colchicine."
]
}
|
Ms. Wentz, a 51-year-old female, was found to have an adenomatous polyp at the ileocecal valve, which was not amenable to colonoscopy resection. She has a past history of pulmonary embolism, diabetes mellitus type 2, obesity, hypercholesterolemia, probable COPD, hypertension, and moderate obstructive sleep apnea. The patient also has a long history of smoking, but quit five months before her admission. The patient is allergic to IV erythromycin, which causes rash. She was taking Lipitor 10 mg once a day, Metformin 500 mg in the morning, 100 mg in the afternoon, Coumadin 11 mg, and Tylenol p.r.n. for joint pain. The patient's Coumadin was withheld a week before operation and was placed on heparin. Her Coumadin was restarted on 7/3/05 and on her home dose of 11 mg. Her INR steadily increased over the course of her hospital stay up to 1.7 at her discharge. The patient was on metformin for her diabetes mellitus, which was withheld on the day of her surgery, and was placed on Regular Insulin sliding scale. She also complained of white creamy discharge from her vagina on 9/29/05 and miconazole suppository was prescribed for five days. At the time of discharge, her discharge from her vagina had resolved. The patient was discharged with DuoNeb 3/0.5 mg q.6h, Coumadin 12 mg p.o. nightly, Lipitor 10 mg p.o. once a day, Metformin p.o. 500 mg in the morning, 1000 mg in the afternoon, Colace 100 mg twice a day p.o., and Dilaudid 2-4 mg q.3h. p.o. The patient will arrange to have her INR draw on 1/1/05 with follow-up INRs to be drained every two days and INR will be followed by her primary care physician, Dr. Afonso. The patient is full code.
|
Has this patient ever been prescribed heparin.
|
{
"answer_end": [
742
],
"answer_start": [
694
],
"text": [
"on heparin. Her Coumadin was restarted on 7/3/05"
]
}
|
75 yo Spanish speaking F was admitted for pre-syncope and discharged on 9/15/04 with full code status to home with medications including TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS with food/drug interaction instruction to avoid grapefruit unless MD instructs otherwise and IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD with food/drug interaction instruction to give on an empty stomach (give 1hr before or 2hr after food) and ZANTAC (RANITIDINE HCL) 150 MG PO BID and CELEBREX (CELECOXIB) 200 MG PO QD with food/drug interaction instruction to take with food with diet of house/low chol/low sat. fat and activity of walking as tolerated. An EKG showed sinus brady and a TSH test was mildly elevated at 5.3. Labs showed an elevated LDL, cardiac enzymes negative, UA negative, Hct 40 at baseline, and an aMIBI 3/24 showed a small reversible defect of mild intensity in the distal ant wall and apex c/w small area ischemia in the distal LAD. The patient was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS on order for ZOCOR PO (ref # 63128567), IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD, ZANTAC (RANITIDINE HCL) 150 MG PO BID, CELEBREX (CELECOXIB) 200 MG PO QD, NSAIDS, and LOVENOX for DVT ppx. The patient was advised of the benefits of ASA for her and was started on 81mg qd and may benefit from EGD as well as increasing Imdur if persistent hypertension. It is important to call Dr. Mcquade for a follow up appointment within the next 1-2 weeks and to take all medications on the discharge list at the doses specified. The patient presents with pre-syncope, hypothyroidism, asthma, left hip pain, headache and polyarthralgias. The patient was monitored on tele and the atenolol could be a contributing factor to the bradycardia and was switched to bid frequency with 1/2 dose (25mg). GI symptoms include dyspepsia and was started on PPI and checked for H.pylori. Endocrine symptoms included a mildly subtherapeutic levoxyl which was increased to 75mcg qd. Pulmonary symptoms included asthma which was continued on albuterol inhaler PRN and DVT ppx with Lovenox. MSK symptoms included trochanteric bursitis which was treated with Tylenol.
|
Has the patient had ecasa ( aspirin enteric coated ) in the past
|
{
"answer_end": [
287
],
"answer_start": [
244
],
"text": [
"ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD,"
]
}
|
Patient Mickey Corkill was admitted to the hospital on 5/29/2004 for dizziness and discharged on 7/17/2004. During this time, the patient was given ACETYLSALICYLIC ACID 81 MG PO QD Starting STAT ( 0/17 ), AMIODARONE 200 MG PO QD, DIGOXIN 0.125 MG PO QD, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, LASIX ( FUROSEMIDE ) 120 MG PO BID, NPH HUMULIN INSULIN ( INSULIN NPH HUMAN ) 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ) 30 MILLILITERS PO QD PRN Constipation, COUMADIN ( WARFARIN SODIUM ) 2 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, NORVASC ( AMLODIPINE ) 10 MG PO QD HOLD IF: SBP < 95, IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR ( LOSARTAN ) 100 MG PO QHS Starting STAT ( 4/13 ), PLAVIX ( CLOPIDOGREL ) 75 MG PO QD Starting STAT ( 0/17 ), NEXIUM ( ESOMEPRAZOLE ) 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, Sliding Scale ( subcutaneously ) SC AC+HS, and HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. Due to the potential for serious interactions between WARFARIN and ASPIRIN, WARFARIN and AMIODARONE HCL, DIGOXIN and AMIODARONE HCL, and SIMVASTATIN and WARFARIN, overrides were added on 8/6/04 and 9/23/04 by various physicians, with the MDs being aware that the patient was already on the regimen at home. The patient was also advised to avoid high Vitamin-K containing foods and to avoid grapefruit unless the MD instructed otherwise. The patient's BB was held while in house because of worry about bradyarrhythmia and hypotension. The patient was also continued on home insulin regimen with coverage with insulin sliding scale, and was found to have a TSH of 158 FT4 1.8, FT3 56. The patient was also started on synthroid to be f/u for hypothyroidism and given prophylaxis with Nexium. Treatment included CV, NEURO, ENDO, and Prophylaxis, with the patient to follow-up with various doctors for management of CHF/BP, potential neurovascular etiology of symptoms, and hypothyroidism. The patient was anticoagulated with ACETYLSALICYLIC ACID 81 MG PO QD, AMIODARONE 200 MG PO QD, WARFARIN 2 MG PO QPM, COLACE 100 MG PO BID, LASIX 120 MG PO BID, NPH HUMULIN INSULIN 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA 30 MILLILITERS PO QD PRN Constipation, COUMADIN 2 MG PO QPM, NORVASC 10 MG PO QD HOLD IF: SBP < 95, IMDUR 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR 100 MG PO QHS, PLAVIX 75 MG PO QD, NEXIUM 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, and SIMVASTATIN 80 MG PO QHS HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. The patient was discussed with the cardiologist, and Coreg was held prior to admit for low BP's, with the plan to d/c pt off Coreg and defer to Dr. Doniel for reinstitution of beta blockade. Neuro exam was normal with no focal signs, and no signs of cerebellar dysfunction. The patient was also started on synthroid to be f/u with endocrine for management of hypothyroidism.
|
has there been a prior levothyroxine sodium
|
{
"answer_end": [
921
],
"answer_start": [
887
],
"text": [
"LEVOTHYROXINE SODIUM 50 MCG PO QD,"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
How often does the patient take prilosec otc
|
{
"answer_end": [
708
],
"answer_start": [
625
],
"text": [
"Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd,"
]
}
|
The patient is a 76-year-old female with a history of mitral regurgitation, congestive heart failure, recurrent UTIs, and uterine prolapse who presented with chills and hypotension and was admitted to the Medical ICU for treatment of septic shock. Mean arterial pressures were kept above 65 with Levophed and antibiotics were changed to penicillin 3 million units IV q.4h. and gentamicin 50 mg IV q.8h. An ATEE on 10/19 showed severe mitral regurgitation with posterior leaflet calcifications and linear density concerning for endocarditis, for which a PICC line was placed on 1/19 for a six-week course of penicillin 3 million units IV q.4h. and two-week course of gentamicin 50 mg IV q.8h. until 2/25. The patient was initially treated with Levophed for her hypotension until 11/0, and was placed on Levofloxacin and Vancomycin to treat Gram-positive cocci bacteremia and UTI. She was maintained on telemetry and was found to be a normal sinus rhythm with ectopy, including short once of nonsustained ventricular tachycardia. She was started on Lopressor 12.5 mg t.i.d. on 3/18, and this was increased to 25 mg b.i.d. at discharge, with her heart rates continuing to be between the 70s and the 90s, however, with less episodes of ectopy. Aspirin was given, and Lipitor was initially held for an initial transaminitis presumed to be secondary to shock liver. She had guaiac positive stools in the medical ICU, her hematocrit was stable around 33%, and her iron studies suggested anemia of chronic disease with possibly overlying iron deficiency. She had a normal random cortisol level of 35.3, and her Hemoglobin A1c was 6.5, so she was maintained thereafter only on insulin sliding scale and rarely required any coverage. The patient was kept on Lovenox and Protonix and her DISCHARGE MEDICATIONS include Aspirin 81 mg daily, iron sulfate 325 mg daily, gentamicin sulfate 50 mg IV q.8h. until 2/25 for a two-week course, penicillin G potassium 3 million units IV q.4h. until 0/12 for a six-week course, Lopressor 25 mg b.i.d., Caltrate plus D2 tablets p.o. daily, Lipitor 10 mg daily, and Protonix 40 mg daily. She was discharged to rehabilitation at Acanmingpeerra Virg Tantblu Medical Center in order to be able to get her antibiotic therapy, and her physicians will attempt to add the ACE back onto her medical regimen for better afterload reduction as her blood pressure tolerates, and potentially they will add her back on to the Lasix as well. She will require weekly lab draws to check her electrolytes and CBC while she is on the antibiotics.
|
Has the patient taken medication for hypotension
|
{
"answer_end": [
783
],
"answer_start": [
704
],
"text": [
"The patient was initially treated with Levophed for her hypotension until 11/0,"
]
}
|
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 the patient ever been on ecasa ( aspirin enteric coated )
|
{
"answer_end": [
323
],
"answer_start": [
279
],
"text": [
"ECASA (Aspirin Enteric Coated) 325 MG PO QD,"
]
}
|
Ms. Wentz, a 51-year-old female, was found to have an adenomatous polyp at the ileocecal valve, which was not amenable to colonoscopy resection. She has a past history of pulmonary embolism, diabetes mellitus type 2, obesity, hypercholesterolemia, probable COPD, hypertension, and moderate obstructive sleep apnea. The patient also has a long history of smoking, but quit five months before her admission. The patient is allergic to IV erythromycin, which causes rash. She was taking Lipitor 10 mg once a day, Metformin 500 mg in the morning, 100 mg in the afternoon, Coumadin 11 mg, and Tylenol p.r.n. for joint pain. The patient's Coumadin was withheld a week before operation and was placed on heparin. Her Coumadin was restarted on 7/3/05 and on her home dose of 11 mg. Her INR steadily increased over the course of her hospital stay up to 1.7 at her discharge. The patient was on metformin for her diabetes mellitus, which was withheld on the day of her surgery, and was placed on Regular Insulin sliding scale. She also complained of white creamy discharge from her vagina on 9/29/05 and miconazole suppository was prescribed for five days. At the time of discharge, her discharge from her vagina had resolved. The patient was discharged with DuoNeb 3/0.5 mg q.6h, Coumadin 12 mg p.o. nightly, Lipitor 10 mg p.o. once a day, Metformin p.o. 500 mg in the morning, 1000 mg in the afternoon, Colace 100 mg twice a day p.o., and Dilaudid 2-4 mg q.3h. p.o. The patient will arrange to have her INR draw on 1/1/05 with follow-up INRs to be drained every two days and INR will be followed by her primary care physician, Dr. Afonso. The patient is full code.
|
has there been a prior heparin.
|
{
"answer_end": [
742
],
"answer_start": [
694
],
"text": [
"on heparin. Her Coumadin was restarted on 7/3/05"
]
}
|
GVERRERO , STAN O 346-21-49-8, a 74 yo woman in remission from Hodgkin's Lymphoma and s/p renal transplant( 11/12 ), was discharged to Home with the attending physician being KERSON , RODNEY S , M.D. and code status being Full code. She was prescribed FESO4 ( FERROUS SULFATE ) 300 MG PO BID, FOLATE ( FOLIC ACID ) 1 MG PO QD, SYNTHROID ( LEVOTHYROXINE SODIUM ) 100 MCG PO QD, PREDNISONE 5 MG PO QAM, ZOCOR ( SIMVASTATIN ) 20 MG PO QHS, NEORAL ( CYCLOSPORINE MICRO ( NEORAL ) ) 100 MG PO BID, LOSARTAN 50 MG PO QD, ATENOLOL 25 MG PO QD, PRILOSEC ( OMEPRAZOLE ) 20 MG PO QD, AMIODARONE 400 MG PO BID, ECASA ( ASPIRIN ENTERIC COATED ) 325 MG PO QD, FLAGYL ( METRONIDAZOLE ) 500 MG PO TID X 2 Days, LEVOFLOXACIN 500 MG PO QD X 2 Days, and DIET: House / Low chol/low sat. fat with instructions for regular exercise and follow up with Dr. Schultheiss ( cardiology ) 5/30/03 scheduled. On order for NEORAL PO ( ref # 55336954 ) with a POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & CYCLOSPORINE override added on 11/0/03 by LIU , HERMAN ANTONIO , M.D., and LOSARTAN PO ( ref # 04133525 ) with a POTENTIALLY SERIOUS INTERACTION: CYCLOSPORINE & LOSARTAN POTASSIUM override added on 11/0/03 by ELVEY , EDMUND LENNY , M.D., Alert overridden: Override added on 5/27/03 by : POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & AMIODARONE HCL Reason for override: aware and POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & LEVOFLOXACIN Reason for override: aware. The patient had a hypoxic episode and EKG changes resolved, requiring 2u PRBCs, and was initially treated with lopressor 5mg IV, eventually rate controlled with dilt drip. PFT's , LFT's and TFT's were completed prior to discharge, and she was instructed to restart ecasa 5d p colonoscopy, as well as to take levofloxacin and flagyl for 5 days, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. Consider anticoagulation for PAF was recommended. On 1/16 she had Afib with RVR to 130s with chest arm pain which is her anginal equivalent. ECG with rate related ischemia ST depression V5-6, L. +Minimal troponin leak to 0.19, which subseq downtrended with nl CK. She was init treated with lopressor 5mg IV but had hypotension to 80's which resolved quickly with IVF. She was eventually rate controlled with dilt drip. She returned to sinus rhythm within the day. Cards c/s'd and recommended amio load. CXR showed no infiltrate/opacity. Levo/Flagyl given empirically x 5days though she remained afeb. Abdominal exam was concerning for focal peritoneal irritation. Her exam improved, and she was tolerating PO well at the time of discharge. She has been afeb and well appearing for several days prior to d/c. Plan to complete 5d abx. As per Dr. Thorburn her colonoscopy was complex, and she had polypectomy of 2.5 cm polyp. Path is pending. If + for cancer, the base looked "clean", so may be feasible to re-scope her for surveillance at a later time, as per GI. Hct after colonoscopy went to 24 ( baseline 30 ); post-transfusion HCt of 30.
|
How often does the patient take folate ( folic acid )
|
{
"answer_end": [
326
],
"answer_start": [
293
],
"text": [
"FOLATE ( FOLIC ACID ) 1 MG PO QD,"
]
}
|
Ms. Lofstrom is a 57-year-old female with a past medical history of hypertension, diabetes mellitus, multinodular goiter, arthritis and questionable recurrent bouts of generalized weakness who was admitted for new onset of right sided weakness, right leg numbness and weakness, right arm clumsiness followed by dysarthria. Laboratory tests showed glucose of 353, sodium 138, potassium 4.9, chloride 98, CO2 28, BUN 33, creatinine 1.1, calcium 10.3, magnesium 2.0, troponin 0.09, white count 8.4, hematocrit 39.8, platelet count 367,000, PT 12.1, PTT 19.5, INR 1.0. An echocardiogram revealed evidence of concentric LVH with preserved systolic function, calculated ejection fraction of 55%, one plus tricuspid regurgitation and normal peak doppler flow velocity across the tricuspid valve. Carotid noninvasive studies showed no evidence of hemodynamically significant disease in either carotid artery. MRI showed a focal area of increased T2 signal in the posterior limb of the left internal capsule, close the genu and a similar smaller area of signal abnormality in the left globus pallidus adjacent to the left internal capsule abnormality. The patient had not taken her insulin for several days prior to admission, and was placed on her regular insulin schedule as well as a sliding scale with blood sugar between 150 and high 200s. Her medications included Hydrochlorothiazide 12.5 milligrams once a day, Norvasc 5 milligrams once a day, Taxol 28 milligrams once a day, Premarin 0.625 milligrams once a day, Trazodone, insulin 12 units of regular and 50 units of NPH in the morning and Ansaid 100 milligrams p.o. b.i.d. p.r.n. joint pain. She was also reportedly taking a baby aspirin 81 milligrams once a day, and was placed on subcu heparin and started on full dose aspirin 325 milligrams p.o. q.d. while her antihypertensives were held in order to maintain a systolic blood pressure between 140-160 with a diastolic blood pressure of 85-90. The patient was rehydrated with IV fluids, and close observation was paid to her electrolytes including her potassium. Rheumatology was consulted and recommended checking a urinalysis to check for red blood cells and casts, which showed no protein, no blood, 0-2 red blood cells, and no casts. He therefore suggested to continue aspirin, but in higher doses to alleviate her left shoulder pain. The patient's Norvasc continued to be held with excellent control of her blood pressure between systolic of 140-160, and should not be reinitiated until roughly ten days after her stroke. Social work was consulted due to a history of abuse by her husband, but no further abuse history was elicited since his death. The patient was considered stable and ready for discharge to a rehabilitation facility.
|
Has the patient had previous fluids.
|
{
"answer_end": [
1990
],
"answer_start": [
1948
],
"text": [
"The patient was rehydrated with IV fluids,"
]
}
|
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone
|
Has this patient ever tried colace
|
{
"answer_end": [
2185
],
"answer_start": [
2085
],
"text": [
"Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid,"
]
}
|
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.
|
What medications has the patient ever tried for a urinary tract infection prevention
|
{
"answer_end": [
1888
],
"answer_start": [
1802
],
"text": [
"She had developed a urinary tract infection with yeast and was started on fluconazole,"
]
}
|
The patient is a 60 year-old woman with adult onset diabetes mellitus, hypertension, and elevated cholesterol admitted with chest pain, bradycardia, and decreased blood pressure. When her blood pressure is elevated, she takes Nifedipine and the pain became three to four out of ten, so she took Cardizem without relief and called EMS. The pain was relieved with the EMTs gave nitroglycerin times two and they found her to have blood pressure of 190/100, heart rate 76, and normal sinus rhythm. They gave two nitrospray, blood pressure decreased to 150/80, heart rate 76, and after two minutes in the vehicle, she had sinus bradycardia at 30-40, blood pressure 120/80. She was given 0.5 mg of Atropine times one without any affect and brought to the hospital with a systolic blood pressure of 100, then suddenly she had bradycardia with heart rate of 30-40 and systolic blood pressure of 75. She was given intravenous fluids and Atropine 0.5 mg times one which increased her blood pressure systolic to 100 and her heart rate increased to 60. On admission, she was given Nifedipine 10 mg p.r.n. for elevated blood pressure, Lasix 20 mg q. day, Glucotrol 15 mg q. day, Cardizem 300 mg q. day, Coumadin 3.75 mg q. day, Colace 100 mg b.i.d., and Iron 325 mg q. day. On discharge, she was given Aspirin 325 mg q. day, Atenolol 50 mg q. day, Lisinopril 10 mg q. day, Pravachol 20 mg q. day, Glucotrol XL 15 mg q. AM, Lasix 20 mg q. day, and Nitroglycerin tablets sublingual p.r.n. chest pain. She underwent exercise tolerance test on a standard Bruce protocol and angiography which showed left main OK, LAD proximal 20%, D2 60%, ostial 90% mid, left circumflex mid 30%, OM2 distal 60-70%, OM1 mild diffuse disease. She underwent PTCA of her diagonal two which went from 90% to 0% stenosis and she received Heparin overnight and the sheaths were pulled on the following day. She is to follow-up in the VERAREA UNIVERSITY HOSPITAL Clinic with Dr. Van Rothenberg.
|
nitroglycerin
|
{
"answer_end": [
399
],
"answer_start": [
335
],
"text": [
"The pain was relieved with the EMTs gave nitroglycerin times two"
]
}
|
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 there been a prior spironolactone
|
{
"answer_end": [
655
],
"answer_start": [
587
],
"text": [
"fluid overload and spironolactone was added to his diuretic regimen."
]
}
|
Mr. Gerache is a 59 yo man with poorly controlled diabetes and asthma who presented with chest pain. He had intermittent chest pain with activity lasting 5 minutes, relieved with rest, as well as shortness of breath when climbing stairs. Cardiac catheterization showed LAD prox 40%, no LCX lesions, no RCA lesions, and R PDA mid 30% lesion. Beta blocker was started, cholesterol was checked (elevated triglycerides 308, total cholesterol 146, HDL 29), statin was started and aspirin was held because of the patient's stated allergy to aspirin (causing asthma type symptoms). He was started on low-dose lisinopril and no prior echo was considered as outpatient. Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient. Hemoglobin A1c is 10.7 and he will need better control of his sugars as outpatient. He has had asthma as a child and no record of PFTs but should obtain as outpatient, with home inhalers continued. Mr. Gaulding currently has good renal function but needs to have his Cr checked after starting the lisinopril. The patient was advised to consider carefully his lifestyle, including diet and exercise plans, and to take medications including VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H PRN Shortness of Breath, ATENOLOL 12.5 MG PO QD Starting IN AM (8/7), NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 60 UNITS QAM; 70 UNITS QPM SC 60 UNITS QAM 70 UNITS QPM, LISINOPRIL 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, FLOVENT (FLUTICASONE PROPIONATE) 44 MCG INH BID, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and make an appointment with his primary care doctor, take his medications as instructed, and follow up with his cardiologist within 4-6 weeks. He was also placed on a House / Low chol/low sat. fat diet, ADA 2100 cals/dy diet, 2 gram Sodium diet. He was discharged with Full code status and disposition to Home.
|
Has this patient ever been treated with -statin
|
{
"answer_end": [
470
],
"answer_start": [
452
],
"text": [
"statin was started"
]
}
|
The patient is a 59 year-old right-handed woman admitted for suspected acute stroke with a PMH of hypertension, hypercholesterolemia, prior TIA vs. stroke, recurrent left Bell's palsy, obesity, allergic rhinitis, history of TIA vs. stroke, obstructive sleep apnea, and chronic renal insufficiency. She was put on Acetylsalicylic Acid 325 mg PO QD, Atenolol 50 mg PO QD Starting in AM (2/11), Atorvastatin 40 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Amlodipine 10 mg PO QD Food/Drug Interaction Instruction, and PRN albuterol and loratadine. She was also placed on aspirin 325 mg qd for stroke and heart prophylaxis and should supplement her diet with folic acid, taking a full dose of aspirin (325 mg) and folate supplementation. She should discuss raising her dose of atorvastatin (Lipitor) with her PCP, because her cholesterol and LDL levels were high this admission and she has an outpt appointment for carotid non-invasive studies 4/0/03.
|
What is her current dose of atenolol
|
{
"answer_end": [
391
],
"answer_start": [
348
],
"text": [
"Atenolol 50 mg PO QD Starting in AM (2/11),"
]
}
|
Randy Szalay is a 60 year old female with DMII, PVD, chronic AF and a DDI pacer on coumadin who has had a history of recurrent LE ulcerations. She was admitted to medicine with an RLE ulcer, diabetic foot ulcer with ? osteo (Plain films negative but early signs may be absent). She was started on Unasyn in the ED and tolerated it, but was allergic to quinolones and cephalosporins. A bone scan was ordered, and wound swab cx grew 2+ staph aureus with susceptibilities showing MRSA. An ID consult was recommended to continue Unasyn and switch to PO linezolid since the pt refused to take bactrim stating allergy to the med. An Ortho consult was done for debridement of the wound to viable tissue, and the pt was to follow up with Dr. Linkous her out pt orthopedist for reconstructive therapy of her right foot after a vascular evaluation. On 10/22, the pt developed a rash on her legs attributed to the Unasyn and was treated with BENADRYL (DIPHENHYDRAMINE HCL) 25 MG PO Q6H PRN Itching and the Unasyn was discontinued. At discharge, the pt had shown marked improvement of both cellulitis and ulcer with the medications FUROSEMIDE 40 MG PO QD HOLD IF: sbp<90, LISINOPRIL 10 MG PO QD HOLD IF: sbp<90, GLYBURIDE 2.5 MG PO QD, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM, LINEZOLID 600 MG PO BID Food/Drug Interaction Instruction, SIMVASTATIN 20 MG PO QHS Starting ON 10/11/2005 (0/7) and BENADRYL (DIPHENHYDRAMINE HCL) 25 MG PO Q6H PRN Itching. She was also instructed to take antibiotics for 7 days and to avoid high Vitamin-K containing foods, resume regular exercise and follow up with out patient care takers, PCP in 1-2 wks, otho, vascular surg, derm, coumadin clinic, and have daily wet to dry wound dressings.
|
What medications has patient been on for diabetic foot ulcer in the past
|
{
"answer_end": [
331
],
"answer_start": [
224
],
"text": [
"(Plain films negative but early signs may be absent). She was started on Unasyn in the ED and tolerated it,"
]
}
|
Mrs. Trudell, a 69-year-old woman with a history of coronary artery disease and a prior infarction in March 1996, presented to the emergency department at 3:00 a.m. with substernal chest pain and nausea. She took two sublingual nitroglycerin with resolution of the pain by 4:00 a.m. On admission, her medications included simvastatin 10 mg q.h.s., sublingual nitroglycerin, enalapril 5 mg b.i.d., aspirin 325 mg q.d., and Atenolol 50 mg b.i.d. Her heart rate and blood pressure were controlled with intravenous medications and she was managed medically until hospital day three when she was taken of the cardiac catheterization laboratory. Cardiac catheterization revealed a 90% plus left anterior descending artery lesion distal to D1 with evidence of thrombus, 60% proximal left circumflex lesion with diffuse disease in the OM1, and a 40% right coronary artery lesion. She underwent PTCA and stenting of her left anterior descending artery lesion followed by ReoPro infusion. Electrocardiogram abnormalities had resolved and cardiac enzymes returned to baseline. On discharge, the patient was instructed to resume a low fat, low cholesterol diet and to take aspirin 325 mg p.o. q.d., simvastatin 10 mg p.o. q.h.s., Ticlid 250 mg p.o. b.i.d. for 11 days, Atenolol 25 mg p.o. b.i.d., and enalapril 20 mg p.o. q.d. She had follow-up with Dr. Kroell and Dr. Brendlinger at a later date.
|
Is the patient currently or have they ever taken nitroglycerin
|
{
"answer_end": [
296
],
"answer_start": [
204
],
"text": [
"She took two sublingual nitroglycerin with resolution of the pain by 4:00 a.m. On admission,"
]
}
|
The patient is a 64 year-old gentleman with a history of chest discomfort, dyspnea on exertion and fatigue who was scheduled for a coronary artery bypass grafting. He had cardiac catheterization at Ryhoagberg Spisus Community Hospital on November, 1999 which demonstrated a 30% tapering lesion of the left main coronary artery, 70% proximal lesion of the left anterior descending coronary artery, 80% lesion distal to D1, 100% occlusion of his left circumflex and a 100% occlusion of his right coronary artery. On March, 1999, he underwent coronary artery bypass grafting times three with a left internal mammary artery to the left anterior coronary artery, saphenous vein graft to the aorta and a saphenous vein graft from the obtuse marginal to the aorta. His intraoperative course was uncomplicated and he was weaned to extubation and he was treated with stress steroids to prevent steroid withdrawal. He was taken back to the operating room for bleeding and was reintubated and was returned in good and stable condition to the intensive care unit on renal Dopamine. He was again extubated and was seen in consultation by the Gastrointestinal Service for a question of gastrointestinal bleed since there was a clot seen on the transesophageal echocardiogram probe at its withdrawal from his first surgery. The Gastrointestinal Service saw any evidence of any upper gastrointestinal bleed and he was maintained on H2 blockers. He was sent to the step down unit on routine postoperative day number two and his Captopril was increased for afterload reduction. He continued to improve and continued to have care for his respiratory situation with continued diuresis and nebulizer treatments and ambulation. He was discharged to the care of Dr. Lou Pineault at Potmend Rehabilitation Hospital, Moorlberl Street with medications including Prednisone 5 mg p.o. twice a day, Enteric coated aspirin 325 mg p.o. q. day, Zantac 150 mg p.o. twice a day, Niferex 150 mg p.o. twice a day, Atrovent nebulizer 0.5 mg four times a day, Timolol eye drops 0.5% one drop in both eyes twice a day, Atenolol 25 mg p.o. twice a day, Captopril 12.5 mg p.o. three times a day, Lasix 40 mg p.o. q. day, Potassium SR 20 mEq p.o. q. day, Simvastatin 40 mg p.o. q. day, and Ibuprofen 200-800 mg as needed for pain q.4-6h.
|
What medicines have previously been tried for pain
|
{
"answer_end": [
2295
],
"answer_start": [
2248
],
"text": [
"Ibuprofen 200-800 mg as needed for pain q.4-6h."
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
Is there history of use of ceftriaxone
|
{
"answer_end": [
1125
],
"answer_start": [
1099
],
"text": [
"CEFTRIAXONE 2,000 MG IV QD"
]
}
|
The patient is a 58-year-old female with chronic renal insufficiency, diabetes mellitus, hypertension, and anemia who presented with two weeks of diffuse abdominal pain that acutely worsened one day prior to admission with associated nausea, nonbloody emesis, and chills. She was initially given a seven-day course of ciprofloxacin and oxycodone for pain, but stopped taking them after developing constipation. She currently presents with complaints of diarrhea and was given ampicillin 2 g IV, gentamicin 80 mg IV, Flagyl 500 mg IV and 8 units of insulin. She was put on levofloxacin, vancomycin, and Flagyl as her left foot had been encasted with evidence of underlying infection, and her blood cultures grew MRSA, which is presumed to need eight weeks of vancomycin. She was put on erythromycin with a change to Reglan on 8/6/06 per renal or liver disease and kept on Compazine for nausea. Later, it was determined that the patient was iron deficient and she was put on iron supplementation and darbepoetin initially and changed to erythropoietin later during dialysis. She was maintained on aspirin, a statin, and calcium channel blocker, and started on prophylactic beta-blocker during her hospital course. Her insulin regimen was titrated to good glycemic response, and she was kept on heparin and Nexium. Other medications included Tylenol 650 mg p.o. q.4. p.r.n. headache, Colace 100 mg p.o. b.i.d., Dilaudid 0.4-0.8 mg p.o. q.4. p.r.n. pain, Insulin NPH human 20 units subq b.i.d., Lopressor 50 mg p.o. q.i.d., Senna tablets two tabs p.o. b.i.d., Norvasc 10 mg p.o. daily, Nephrocaps one tab p.o. daily, Insulin Aspart sliding scale subq a.c., Lipitor 80 mg p.o. daily, Protonix 40 mg p.o. daily, Vancomycin 1 g IV three times a week, Reglan 5 mg p.o. q.a.c., Reglan 5 mg p.o. q.h.s., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Ergocalciferol 50,000 units p.o. q. week for six weeks, Aspirin 81 mg p.o. daily, Heparin 5000 units subq t.i.d., and Lactulose 30 mL p.o. q.i.d. p.r.n. constipation.
|
Is there a mention of of erythropoietin usage/prescription in the record
|
{
"answer_end": [
1072
],
"answer_start": [
1024
],
"text": [
"changed to erythropoietin later during dialysis."
]
}
|
The patient, a 72-year-old male, was admitted for an incarcerated chronic ventral hernia post sigmoid colectomy, colostomy, and Hartmann's operation. His hospital course was complicated by postoperative acute respiratory failure, respiratory acidosis with metabolic acidosis, pleural effusion, hypokalemia, myocardial infarction, thrombocytopenia, and delirium. He had a known history of penile cancer status post penectomy complicated by perineal urethrocutaneous fistula, chronic anemia requiring transfusions, non-insulin-dependant diabetes, hypertension, hypercholesterolemia, obesity, and recurrent UTIs. He was given a suprapubic catheter placed by Urology and was started on TPN after a PICC line was placed. He was scoped by GI on 6/20/07, which showed diffuse gastritis thought to be due to the NG tube, and two ulcers turned out to be bleeding. His discharge medications included Tylenol 325 to 650 mg p.o. q.4 h. p.r.n. pain, DuoNeb 3/0.5 mg q.6 h. p.r.n., amiodarone 400 mg p.o. b.i.d. for six more days and then 400 mg p.o. daily, hold for systolic less than 90, heart rate less than 55, econazole nitrate topical daily, heparin 5000 units subcutaneously q.12 h., Regular Insulin sliding scale subcutaneously q.6 h., Imodium A-D 2 mg p.o. b.i.d., metoclopramide 10 mg p.o. q.i.d., Lopressor 50 mg p.o. q.6 h., hold for systolic less than 90, heart rate less than 55, omeprazole 40 mg p.o. b.i.d., oxycodone 1 mg per 1 mL solution for a total of 5 mg p.o. q.4 h. p.r.n. pain, Carafate 1 gm p.o. q.i.d., and Ambien 2.5 mg p.o. nightly. He was not anti-coagulated for his Atrial Fibrillation due to his risk of GI bleeding, as decided by GI. He was discharged on TPN as his total caloric needs were still not being met by p.o. nutrition and he was in good condition on discharge.
|
Is there history of use of ambien
|
{
"answer_end": [
1546
],
"answer_start": [
1519
],
"text": [
"Ambien 2.5 mg p.o. nightly."
]
}
|
The patient had continued to remain stable from an ischemia standpoint and a beta-blocker was added back to his regimen and was titrated to a dose of Lopressor 12.5 mg p.o. t.i.d. He continues on aspirin and statin, and he also continues on Isordil 20 mg p.o. t.i.d. and hydralazine 50 mg p.o. t.i.d. for after load reduction, as well as digoxin at 0.125 mg p.o. q.o.d. The patient was aggressively diuresed with intravenous Lasix and Zaroxolyn followed by conversion to oral diuresis with torsemide at the dose of 100 mg p.o. q.d. He was also found to have atrial clot on transesophageal echocardiogram and thus was started on a heparin drip and transitioned on Coumadin, but after a discussion with the CHF Team, the decision was made not to continue Coumadin anticoagulation and instead he was given aspirin and Plavix at full doses. The patient's medication regimen also includes Colace 100 mg p.o. b.i.d., Folate 1 mg p.o. q.d., Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough, Simethicone 80 mg p.o. q.i.d. p.r.n. upset stomach, Multivitamin one tab p.o. q.d., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Tessalon 100 mg p.o. t.i.d. p.r.n. cough, Lipitor 80 mg p.o. q.d., Plavix 75 mg p.o. q.d., Lantus 5 units subcu q.p.m., NovoLog 3 units subcu a.c. and NovoLog sliding scale. The patient is on ACE inhibitor and was restarted on a low-dose beta-blocker at 12.5 mg p.o. t.i.d. as well as his insulin regimen can be adjusted as an outpatient and possibly oral diabetes medications restarted. He is to be discharged to the Com Medical Center for further rehabilitation, with follow-up appointments with Dr. Kyle Yandle in the T Las on 2/28/05 at 08:30 a.m., Dr. Clyde Chatampaya of Elmert Hospital Cardiology 9/26/05 and Raymond Banaag of TRISTONTERN MEDICAL CENTER PCP on 10/3/05 at 01:50 p.m. His sister, Alexis Fernendez, is his health care proxy and is providing substantial social support.
|
Has a patient had heparin
|
{
"answer_end": [
672
],
"answer_start": [
613
],
"text": [
"was started on a heparin drip and transitioned on Coumadin,"
]
}
|
Summary: This is a 22 year old gravida V para 0314 at 24 weeks, who presented with a three and a half day history of severe frontal headaches with scintillations and marked polydipsia for four days, with no relief from Tylenol, aspirin or Fioricet. She had a history of preeclampsia with a previous twin gestation, chronic hypertension, seizure disorder following motor vehicle accident for which she is on valproic acid, no clearly documented recent seizures, history of asthma for which she takes medicines p.r.n., history of behavioral disorders with question of organic or psychogenic origin, obesity, multiple drug allergies, cholecystectomy in 1990, appendectomy at age 14, motor vehicle accident with V-P shunt placement in 1980, facial reconstruction times three in 1980, and superficial vascular surgery in 1989 for varicosities of the lower extremities. Symptoms were not completely relieved by Demerol, Percocet or Tylenol, however, she was eventually tried on Fioricet which provided some relief and was at least briefly maintained on hydrochlorothiazide before admission. She was begun on a beta blocker, namely labetolol, with good control and was discharged to home on labetolol. Intravenous hydration was initially provided for nausea and vomiting, however, she declined further IV's and was discharged for a trial of outpatient management. Follow up is in the clinic. She was taking a small dose of valproic acid apparently on her own throughout this pregnancy.
|
fioricet.
|
{
"answer_end": [
248
],
"answer_start": [
199
],
"text": [
"with no relief from Tylenol, aspirin or Fioricet."
]
}
|
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week.
|
How much haldol does the patient take per day
|
{
"answer_end": [
760
],
"answer_start": [
701
],
"text": [
"she required rather significant doses of Zyprexa and Haldol"
]
}
|
A 74-year-old female with pulmonary sarcoid, CHF, and CRI presented with SOB after stopping Lasix several weeks ago. On admission, she was in mildly decompensated CHF and was started on more aggressive diuresis with Lasix 40 IV BID increased to 80 BID on HD2, with Cardiology Service consulting, then increased to Lasix drip at 15/hr on HD3 with I/O goal 1-2 l neg. She did well on this and by HD5 was near her dry weight of 49kg and her drip was transitioned back to PO Lasix. She was continued on Hydralazine, Lopressol and Isordil on HD3, titrated up to 20 TID. She has history of MI with stents and was continued on ASA, Plavix, Zocor, Coumadin (ref#960263524) PO, MVI Therapeutic 1 TAB PO QD, Iron Sulfate 325 MG PO TID, Folate 1 MG PO QD, Calcium Carbonate 500 MG PO TID, Acetylsalicylic Acid 81 MG PO QD, Colace 100 MG PO BID, Prednisone 10 MG PO QAM, Sodium Bicarbonate 325 MG PO TID, Flovent 220 MCG INH BID, Bactrim DS, Plavix 75 MG PO QD, Esomeprazole 40 MG PO QD, Duoneb, Glipizide XL 2.5 MG PO QD, Vit. B-3, Lipitor 40 MG PO QD, Atorvastatin Calcium, Lovenox 50 MG SC QD, and Insulin Regular Human (Sliding Scale subcutaneously SC AC: if BS is 125-150, then give 2 units; if BS is 151-200, then give 3 units; if BS is 201-250, then give 4 units; if BS is 251-300, then give 6 units; if BS is 301-350, then give 8 units; if BS is 351-400, then give 10 units). She was discharged to Wadesdi Ckgart Community Hospital at a euvolemic state with a dry weight of 49kg, continuing on Lasix 80 PO BID unless Cr rises above new baseline of 3.5 or if she gains weight or shows signs of new overload, and Lovenox should be stopped once her INR is >2. Coumadin dose should be adjusted according to INR goal 2-3, and she should be on a renal diet with low potassium and low glucose but with diabetic caloric supplements like GLUCERNA. She should receive a HOT PACK to her neck 2-3x per day and to her vein before blood draw for comfort, physical therapy daily with the goal of gait stability, home safety, and good O2 sats on 2L O2, and VNA services for meds. She should follow up with PCP, renal, and cardiology, and return to the hospital or call doctor if she experiences worsening SOB, fever over 100.5, chest pain, decreased urine output, weight gain over 5 pounds, or any other concerning symptoms. The patient was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 500 MG PO TID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, IRON SULFATE (FERROUS SULFATE) 325 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, LASIX (FUROSEMIDE) 80 MG PO BID, HYDRALAZINE HCL 25 MG PO TID HOLD IF: SBP<90, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC AC, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO TID, DILANTIN (PHENYTOIN) 100 MG PO QID, POTENTIALLY SERIOUS INTERACTION: PHENYTOIN & WARFARIN, PREDNISONE 10 MG PO QAM, SODIUM BICARBONATE 325 MG PO TID, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, SERIOUS INTERACTION: SULFAMETHOXAZOLE & WARFARIN, MVI THERAPEUTIC (THERAPE
|
Has patient ever been prescribed mvi therapeutic ( therapeutic multivitamins )
|
{
"answer_end": [
697
],
"answer_start": [
669
],
"text": [
"MVI Therapeutic 1 TAB PO QD,"
]
}
|
This is a 47-year-old female with a history of HIV, diabetes, questionable cerebral aneurysm, and seizure disorder who recently had two syncopal events without prodrome and without postictal state, who presented for evaluation of left arm paresthesias and chest pain, with associated diaphoresis, shortness of breath and nausea. Of note, the patient recently started Flexeril to treat chronic low back pain, was not receiving her Keppra for approximately a year, as her prescription had ran out, and was instead taking Ecotrin 81 mg daily, clonazepam 1 mg q.6 h. p.r.n., Imodium one to two tablets q.i.d. p.r.n. for diarrhea, and low-dose aspirin. The patient was started on low-dose beta-blocker and aspirin, metoprolol 12.5 b.i.d. with occasional bradycardia to the high 40's, and was treated with the Ryo Hospital Medical Center insulin protocol. The patient was restarted on Keppra 250 mg b.i.d. with a goal to increase to 500 mg b.i.d. after 7 days and to 750 mg after another week, and was given Keppra 500 mg b.i.d. for 14 doses and then 750 mg b.i.d., Flexeril 5 mg daily, clonazepam 1 mg q.i.d., Truvada one tablet p.o. daily, Norvir 1400 mg b.i.d., glyburide 5 mg q.a.m. and 2.5 mg q.p.m., Lomotil one tablet q.i.d. p.r.n., methadone 150 mg daily, Zofran 4 mg daily p.r.n., Percocet 325 mg/5 mg tablets one tablet q.6 h. p.r.n., Zantac 150 mg b.i.d., Zoloft 100 mg q.a.m., and trazodone 100 mg nightly. Labs revealed a low reticulocyte index consistent with anemia of chronic disease, and the methadone dose of 155 mg was confirmed with the outpatient clinic. The patient was also given three doses of Klonopin over a six-day period, instructed to take medications as listed, clarify discrepancies with her PCP, return to the ER for evaluation if she faints again, call her PCP and/or return to the ER if her chest pain symptoms recur and persist, make an appointment with the Smill Memorial Hospital to evaluate the cause of her left arm symptoms, and check her blood sugars before meals and at bedtime. Additionally, her PCP was instructed to arrange for a loop monitor, follow up on a 24-hour urine studies assessing for pheochromocytoma, and adjust the patient's diabetes management as needed.
|
Has this patient ever been treated with lomotil
|
{
"answer_end": [
1233
],
"answer_start": [
1200
],
"text": [
"Lomotil one tablet q.i.d. p.r.n.,"
]
}
|
Mr. Gerache is a 59 yo man with poorly controlled diabetes and asthma who presented with chest pain. He had intermittent chest pain with activity lasting 5 minutes, relieved with rest, as well as shortness of breath when climbing stairs. Cardiac catheterization showed LAD prox 40%, no LCX lesions, no RCA lesions, and R PDA mid 30% lesion. Beta blocker was started, cholesterol was checked (elevated triglycerides 308, total cholesterol 146, HDL 29), statin was started and aspirin was held because of the patient's stated allergy to aspirin (causing asthma type symptoms). He was started on low-dose lisinopril and no prior echo was considered as outpatient. Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient. Hemoglobin A1c is 10.7 and he will need better control of his sugars as outpatient. He has had asthma as a child and no record of PFTs but should obtain as outpatient, with home inhalers continued. Mr. Gaulding currently has good renal function but needs to have his Cr checked after starting the lisinopril. The patient was advised to consider carefully his lifestyle, including diet and exercise plans, and to take medications including VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H PRN Shortness of Breath, ATENOLOL 12.5 MG PO QD Starting IN AM (8/7), NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 60 UNITS QAM; 70 UNITS QPM SC 60 UNITS QAM 70 UNITS QPM, LISINOPRIL 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, FLOVENT (FLUTICASONE PROPIONATE) 44 MCG INH BID, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and make an appointment with his primary care doctor, take his medications as instructed, and follow up with his cardiologist within 4-6 weeks. He was also placed on a House / Low chol/low sat. fat diet, ADA 2100 cals/dy diet, 2 gram Sodium diet. He was discharged with Full code status and disposition to Home.
|
How much ventolin nebulizer ( albuterol nebulizer ) does the patient take per day
|
{
"answer_end": [
1270
],
"answer_start": [
1215
],
"text": [
"VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H"
]
}
|
The patient is a 71-year-old male with a history of nonischemic dilated cardiomyopathy, diabetes, obstructive sleep apnea, obesity hypoventilation syndrome, and atrial flutter status post ablation. He presented with shortness of breath and a witnessed apneic episode with loss of consciousness and cyanosis. In the Centsshealt Careman Inerist Medical Center Emergency Department, he was found to be saturating 91% on room air and 99% on a nonrebreather with a pH of 7.31 and a PCO2 of 55; he was tried on BiPAP without improvement in either PCO2 or PO2. He was admitted to the CCU with CHF/apnea/sinus arrest and had a history of having stopped his Lasix dose one week prior. He was initially treated with x1 , Solu-Medrol , and DuoNebs in the ED, and ultimately treated with diuresis and a pacemaker placement. On admission, he was maintained on captopril, which was up titrated to 25 mg t.i.d. (held at one point due to the rise in the creatinine), titrated up on metoprolol to 25 mg b.i.d., antibiotics, Allopurinol 100 mg p.o. daily, Iron, Lisinopril, Toprol-XL, Coumadin (discontinued on 2/4/05), Albuterol inhaler p.r.n., Aspirin, Flomax, Hytrin, Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Flomax 0.4 mg p.o. daily, Nexium 20 mg p.o. daily, Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05, Lasix 40 mg p.o. daily, and Regular Insulin sliding scale subcutaneous q.a.c. He was followed by the Electrophysiology Service and had sinus arrest of 8-9 seconds in the setting of apnea in the CCU, and 4 seconds in the setting of apnea on the floor. He underwent pacemaker placement through cephalic veins, and was started on antibiotics following his pacemaker placement, which included cefazolin while in-house, followed by Keflex, and he was expected to stay on Keflex for four days. He was discharged with medications including Albuterol inhaler two puffs inhaled q.i.d. p.r.n. wheezing, Allopurinol 100 mg p.o. daily, Captopril 25 mg p.o. t.i.d., Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Lasix 40 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Regular Insulin sliding scale subcutaneous q.a.c., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05., Flomax 0.4 mg p.o. daily, and Nexium 20 mg p.o. daily.
|
What is the dosage of flomax
|
{
"answer_end": [
1352
],
"answer_start": [
1327
],
"text": [
"Flomax 0.4 mg p.o. daily,"
]
}
|
This is a 56-year-old female transferred from the Internal Medicine Service for acute cholecystitis, presenting with abdominal pain, nausea, vomiting, and shortness of breath. A CT scan showed an inflamed gallbladder. Past medical history includes hypertension, hypercholesterolemia, and diabetes mellitus type 2 (untreated). Outpatient medications included Atenolol 50 mg p.o. daily, hydrochlorothiazide 25 mg p.o. daily, and Nexium 40 mg p.o. daily. No known drug allergies were present. The patient underwent an open cholecystectomy on 8/21/2005 with no complications. On discharge, medications included Aspirin 81 mg p.o. daily, atenolol 50 mg p.o. daily, hydrochlorothiazide 25 mg p.o. daily, and Lipitor 40 mg p.o. daily. The patient was instructed to follow up with Dr. Store for wound check and staple removal, and with her primary care doctor, as she likely has untreated diabetes and needs to be started on new medications.
|
Is the patient currently or have they ever taken aspirin
|
{
"answer_end": [
659
],
"answer_start": [
598
],
"text": [
"included Aspirin 81 mg p.o. daily, atenolol 50 mg p.o. daily,"
]
}
|
This is a 61-year-old gentleman with severe pulmonary hypertension secondary to chronic PEs, OSA, gout, bilateral hip replacements who presents with two falls in the past two days. He was compliant with his medication regimen and denies dietary indiscretion. He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5, initially being supertherapeutic with a daily goal of negative 500 to 1 L with IV Lasix once or twice a day as needed, his home dose being 160 mg p.o. His baseline room air oxygen saturation was 90-93% and he should use oxygen as treatment for his pulmonary hypertension and be provided with oxygen at home. He was treated for his hip pain initially with oxycodone which was changed to Dilaudid for better pain control, and he should be changed back to his home dose of oxycodone when discharged. He also has a history of gout which was exacerbated with diuresis and he is on his home doses of allopurinol and colchicine, Indocin being added and he should receive a total of three days of Indocin. Tylenol and narcotics as previously described can be used to help with his gouty pain. His GI regimen includes Nexium at home and Prilosec while an inpatient, and he should be switched back to Nexium when discharged from rehabilitation. His lab results on discharge include a creatinine of 1, hematocrit of 53.1 and INR of 2.3, potassium being 3.9 and magnesium being 2.0. The discharge medications include Coumadin 11 mg on Monday, Wednesday and Friday and 12 mg the other days of the week, Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day, hydrochlorothiazide 25 once a day, Lasix 160 IV once per day, allopurinol 200 once per day, colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain, Tylenol 500-1000 mg p.o. q.6 h. p.r.n. pain not to exceed 4 gm total from all sources in a 24-hour period, Ambien 10 mg p.o. nightly p.r.n. insomnia. He is being discharged to rehab with a followup with his cardiologist, Dr. Insco, and an appointment with Endocrinology.
|
What is the current dose of tylenol
|
{
"answer_end": [
1912
],
"answer_start": [
1826
],
"text": [
"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"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
What medications has this patient tried for his bph.
|
{
"answer_end": [
1474
],
"answer_start": [
1435
],
"text": [
"he was continued on Flomax for his BPH."
]
}
|
A 73-year-old male patient with a history of coronary artery disease, ischemic cardiomyopathy, and valvular heart disease was admitted to the Rose-le Medical Center with a large left foot toe ulcer that was nonhealing, and signs and symptoms of decompensated heart failure and acute on chronic renal failure. During his stay, he was treated with Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Colace 100 mg p.o. b.i.d., insulin NPH 7 units q.a.m. and 3 units q.p.m. subcutaneously, Atrovent HFA inhaler 2 puffs inhaled q.i.d. p.r.n. for wheezing, magnesium gluconate sliding scale p.o. daily, oxycodone 5-10 mg p.o. q. 4h. p.r.n. pain, senna tablets one to two tablets p.o. b.i.d. p.r.n. constipation, spironolactone 25 mg p.o. daily, Coumadin 1 mg p.o. every other day, multivitamin therapeutic one tablet p.o. daily, Zocor 40 mg p.o. daily, torsemide 100 mg p.o. daily, OxyContin 10 mg p.o. b.i.d., Cozaar 25 mg p.o. daily, Remeron 7.5 mg p.o. q.h.s., and aspartate insulin sliding scale, as well as being maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., solsite topical, and 25 mg of hydrochlorothiazide b.i.d. 30 minutes prior to meals, in addition to ciprofloxacin, DuoDERM, BKA site healing with continued aspirin, and inhaled ipratropium. Hyponatremia due to heart failure was improved with diuresis, and the patient was maintained on Coumadin with an INR goal of 2-3, adjusted to 1 mg PO every other day. Diabetes mellitus, insulin-dependent, was covered on NPH QAM and QPM with aspartate sliding scale for duration of hospitalization. The patient was restarted on Celexa per PCP for likely depressive mood response to recent bilateral knee amputation, and later started on Remeron 7.5 mg PO daily in place of Celexa. He was initially treated for urinary tract infection with uncomplicated course with ciprofloxacin, and Wound care nurse consulted for BKA wound and small decubitus on his back, was treated with DuoDERM, BKA site healing well. The patient was maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis during this hospitalization. He was discharged on Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Atrovent one to two puffs inhaled q.i.d. p.r.n. for wheezing, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, enteric-coated aspirin 325 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., therapeutic multivitamin one tablet p.o. daily, solsite topical, and instructed to follow up with psychiatry to assess depressive disorder/adjustment disorder, start beta-blocker at a low-dose in the outpatient setting, and check creatinine and BUN along with electrolytes to make sure patient is doing well on current maintenance diuretic schedule of 100 mg torsemide PO daily and spironolactone. Code status was full code.
|
How much lantus does the patient take per day
|
{
"answer_end": [
2658
],
"answer_start": [
2551
],
"text": [
"enteric-coated aspirin 325 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d.,"
]
}
|
A 45-year-old male with morbid obesity presented with chest pain and hypertensive urgency. He was ruled out for MI with negative serial enzymes and EKGs and a cardiac PET showed 2 small areas of reversible ischemia in the mid PDA and distal LAD territory. For CV treatment, he was given Aspirin 81mg PO daily, beta blocker, and HCTZ 25mg PO daily and Atenolol 50mg PO daily for HTN control. For Pulmonary issues, he had very mild asthma exacerbation and a restrictive ventilatory defect from obesity and was given Advair 500/50 BID, Albuterol Nebulizer 2.5 mg neb q2h, Albuterol Inhaler 2 puff inh qid PRN Shortness of Breath and prednisone 60mg QD x 3 doses. For GI issues, he had trace guaiac+ stool and a viral gastroenteritis causing diarrhea and some nausea. For endocrine issues, his A1C was 7.4 and he was educated on low sugar, low carbohydrate diet. For prevention, he was given Lovenox BID. Additional comments included taking HCTZ 25mg daily and Atenolol 50mg daily for blood pressure, eating a low sugar, low carbohydrate diet, and follow-up with cardiology on 11/0. He was discharged in a stable condition with a recommendation for monitor blood sugars and A1C, outpatient colonoscopy, and consider statin therapy, as well as Fluticasone Propionate/Salmeterol 250/50 1 puff inh BID, Albuterol Inhaler 2 puff inh QID, Artificial Tears 2 drop OD TID, Loratadine 10 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Albuterol Nebulizer 2.5 mg neb q4h, Acetylsalicylic Acid 81 mg PO daily, and Miconazole Nitrate 2% powder topical TP daily.
|
What medications has this patient tried for weight
|
{
"answer_end": [
900
],
"answer_start": [
875
],
"text": [
"he was given Lovenox BID."
]
}
|
Ms. Wentz, a 51-year-old female, was found to have an adenomatous polyp at the ileocecal valve, which was not amenable to colonoscopy resection. She has a past history of pulmonary embolism, diabetes mellitus type 2, obesity, hypercholesterolemia, probable COPD, hypertension, and moderate obstructive sleep apnea. The patient also has a long history of smoking, but quit five months before her admission. The patient is allergic to IV erythromycin, which causes rash. She was taking Lipitor 10 mg once a day, Metformin 500 mg in the morning, 100 mg in the afternoon, Coumadin 11 mg, and Tylenol p.r.n. for joint pain. The patient's Coumadin was withheld a week before operation and was placed on heparin. Her Coumadin was restarted on 7/3/05 and on her home dose of 11 mg. Her INR steadily increased over the course of her hospital stay up to 1.7 at her discharge. The patient was on metformin for her diabetes mellitus, which was withheld on the day of her surgery, and was placed on Regular Insulin sliding scale. She also complained of white creamy discharge from her vagina on 9/29/05 and miconazole suppository was prescribed for five days. At the time of discharge, her discharge from her vagina had resolved. The patient was discharged with DuoNeb 3/0.5 mg q.6h, Coumadin 12 mg p.o. nightly, Lipitor 10 mg p.o. once a day, Metformin p.o. 500 mg in the morning, 1000 mg in the afternoon, Colace 100 mg twice a day p.o., and Dilaudid 2-4 mg q.3h. p.o. The patient will arrange to have her INR draw on 1/1/05 with follow-up INRs to be drained every two days and INR will be followed by her primary care physician, Dr. Afonso. The patient is full code.
|
Is there history of use of tylenol
|
{
"answer_end": [
618
],
"answer_start": [
588
],
"text": [
"Tylenol p.r.n. for joint pain."
]
}
|
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage.
|
Previous colace.
|
{
"answer_end": [
593
],
"answer_start": [
577
],
"text": [
"B12, and Colace."
]
}
|
This 66-year-old male with a history of CAD, MI, CABG, and PCI was admitted with chest pain and ongoing risk factors. His enzyme on presentation was negative and EKG showed nonspecific T wave flat in II, III and V2-V3. In the ED, he had a BP of 86/118 and was given NITROGLYCERIN 1/150 (0.4 mg) SL q5min x 3 with no relief; his CP was 10/10 and reduced to 4/10 with NITROGLYCERIN. Labs showed elevated BUN/Cr and mild-mod lateral wall ischemia. He was prescribed ASA 325 mg PO QD, AMIODARONE 200 mg PO BID, LOPRESSOR (METOPROLOL TARTRATE) 50 mg PO BID, ISOSORBIDE DINITRATE 30 mg PO TID (hold if sbp<100), IMDUR 60 mg PO BID, PLAVIX 75 mg PO QD, Protonix, KEFLEX (CEPHALEXIN) 500 mg PO QID, Lasix 60 mg PO BID, KCl 40 mg PO QD, Metformin 500 mg PO BID, Micronase 10 mg PO BID, Tylenol with Codeine PRN, and Ativan 5 mg PRN. He was also advised to follow-up with his PCP to discuss starting Coumadin therapy given his history of atrial fibrillation, and was instructed to take PPI for GERD and a PPI and SC Hep for ppx. He was discharged with stable condition, and lab results showed normal WBC and no signs of acute infection. The patient was also advised to continue taking POTASSIUM CHLORIDE & RAMIPRIL, ALTACE (RAMIPRIL) 1.25 mg PO QD, NEXIUM (ESOMEPRAZOLE) 20 mg PO QD, DIET: House/Low chol/low sat. fat, ACTIVITY: Resume regular exercise, and FOLLOW UP APPOINTMENT(S): Please see your PCP in Own within 2 weeks.
|
Has the patient had multiple nexium ( esomeprazole ) prescriptions
|
{
"answer_end": [
1273
],
"answer_start": [
1239
],
"text": [
"NEXIUM (ESOMEPRAZOLE) 20 mg PO QD,"
]
}
|
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
|
What treatments if any has the patient tried for her pain in the past
|
{
"answer_end": [
2875
],
"answer_start": [
2835
],
"text": [
"she was given oxycodone p.r.n. for pain,"
]
}
|
A 42-year-old male was admitted on 4/30 with congestive heart failure exacerbation, hyperhomocysteinemia, chronic renal failure, obesity, hypercholesterolemia, h/o DVT, asthma, OSA, and a worsening of his dyspnea of exertion (DOE) to 3 miles of flat ground with a suspicion of multifocal pneumonia (PNA). He had a D-dimer of 1400, BNP of 2009, and Troponin of 0.84-0.54, which was not considered ischemic, and was not treated. On this admission, his D-dimer was 1207, BNP was 2917, and Troponin was not sent. He had a JVP to earlobe, bibasilar rales, no wheezes, and diffuse pitting edema to his bilateral shins. He had a chest X-ray (CXR) showing increased bilat LL opacities to the periphery with some cephalization of vessels and some opacification. An electrocardiogram (ECG) showed 98 bpm with left anterior fascicular block (LAE) and strain. A chest CT scan from 8/18 (comparing to 4/30) showed per pulm c/w scarring/persistent changes after recent multifocal PNA 4/30, no e/o of new primary lung path, and ground glass c/w pulmonary edema. An echocardiogram showed an ejection fraction (EF) of 25%, moderate right ventricular (RV) dysfunction, and severe tricuspid regurgitation (TR). A follow-up cardiac MRI from 10/16 showed an EF of 23%, global hypokinesis, no wall motion abnormality (WMA), normal RV, and no valve disease. In the ED, he received Duonebs, ASA 325, and Lasix 80mg. His shortness of breath was secondary to CHF exacerbation and fluid overload with no evidence of an infectious pulmonary process contributing to his symptoms. His hypertension was most likely due to taking the wrong dose of Coreg (taking QOD instead of BID). On a BID Coreg regimen, his BP was much better controlled. His renal function remained stable but impaired while he was being evaluated for dialysis as an outpatient but no vascular access was placed yet. He was discharged on 6/7/05 with a full code status and disposition to home with food/drug interaction instruction to take consistently with meals or on empty stomach and activity to walk as tolerated with follow up appointments with Dr. Sackrider at ACH 5/6/05 at 1:30 PM scheduled, Dr. Dauphin at CMC 0/4/05 at 1:40 PM scheduled. He was discharged with ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #55946845) to address a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, PHOSLO (CALCIUM ACETATE) 667 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, DIOVAN (VALSARTAN) 160 MG PO QD prescribed by his cardiologist, CARVEDILOL 6.25 MG PO BID HOLD IF: HR < 60, or SBP < 100, NEPHROCAPS (NEPHRO-VIT RX) 1 TAB PO QD, with an alert overridden: Override added on 4/7/05 by ALAMIN, NORMAN B., M.D. POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: MD Aware, LIPITOR (ATORVASTATIN) 20 MG PO QD with an alert overridden: Override added on 6/7/05 by: POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: home med, and LASIX (FUROSEMIDE) 80 MG PO BID, with a d/c JVP 10cm. He had not been taking his Lasix for 2d prior to d/c. Pt was instructed to diurese further at home on Lasix 80 BID and continue on Coumadin for his h/o recent DVT (4/30) and INR 2-3.
|
has there been a prior atorvastatin calcium
|
{
"answer_end": [
2952
],
"answer_start": [
2901
],
"text": [
"ATORVASTATIN CALCIUM Reason for override: home med,"
]
}
|
A 56-year-old morbidly obese female with abdominal skin laxity due to massive weight loss after gastric bypass was admitted to plastics for panniculectomy. The patient tolerated the procedure without difficulty and the post-operative period has been uneventful. At discharge, the patient is afebrile with stable vitals, taking PO's/voiding q shift and has ambulated independently with some difficulty given body habitus. Pain has been well managed and incisions are clean, dry, and intact. JP's with moderate serosanguinous output remain in place. The patient was discharged to rehab in a stable condition, with instructions to continue antibiotics as long as drains are in place, change drain sponges daily, strip drains twice daily, sponge baths only while drains are in place, walking as tolerated, no lifting more than 10 pounds, no jogging, swimming, or aerobics for 4-6 weeks, and to monitor/return for signs of infection. Medications prescribed include TYLENOL (Acetaminophen) 1000 mg PO Q6H, KEFLEX (Cephalexin) 500 mg PO QID, COLACE (Docusate Sodium) 100 mg PO BID, PEPCID (Famotidine) 20 mg PO BID, DILAUDID (Hydromorphone HCL) 2-4 mg PO Q4H PRN Pain, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC Q4H Low Scale, LEVOTHYROXINE SODIUM 75 mcg PO daily, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MILK OF MAGNESIA (Magnesium Hydroxide) 30 milliliters PO daily PRN Constipation, METOCLOPRAMIDE HCL 10 mg IV Q8H PRN Nausea, QUINAPRIL 20 mg PO daily, SIMETHICONE 40 mg PO QID PRN Upset Stomach, Other:gas, and STYKER PAIN PUMP (Bupivacaine 0.5%) 400 milliliters IV Q24H Instructions: Rate = 4ml/hr. The patient has a probable allergy to Morphine and Code Status is Full Code.
|
Has the pt. ever been on pepcid ( famotidine ) before
|
{
"answer_end": [
1108
],
"answer_start": [
1075
],
"text": [
"PEPCID (Famotidine) 20 mg PO BID,"
]
}
|
A 73-year-old male patient with a history of coronary artery disease, ischemic cardiomyopathy, and valvular heart disease was admitted to the Rose-le Medical Center with a large left foot toe ulcer that was nonhealing, and signs and symptoms of decompensated heart failure and acute on chronic renal failure. During his stay, he was treated with Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Colace 100 mg p.o. b.i.d., insulin NPH 7 units q.a.m. and 3 units q.p.m. subcutaneously, Atrovent HFA inhaler 2 puffs inhaled q.i.d. p.r.n. for wheezing, magnesium gluconate sliding scale p.o. daily, oxycodone 5-10 mg p.o. q. 4h. p.r.n. pain, senna tablets one to two tablets p.o. b.i.d. p.r.n. constipation, spironolactone 25 mg p.o. daily, Coumadin 1 mg p.o. every other day, multivitamin therapeutic one tablet p.o. daily, Zocor 40 mg p.o. daily, torsemide 100 mg p.o. daily, OxyContin 10 mg p.o. b.i.d., Cozaar 25 mg p.o. daily, Remeron 7.5 mg p.o. q.h.s., and aspartate insulin sliding scale, as well as being maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., solsite topical, and 25 mg of hydrochlorothiazide b.i.d. 30 minutes prior to meals, in addition to ciprofloxacin, DuoDERM, BKA site healing with continued aspirin, and inhaled ipratropium. Hyponatremia due to heart failure was improved with diuresis, and the patient was maintained on Coumadin with an INR goal of 2-3, adjusted to 1 mg PO every other day. Diabetes mellitus, insulin-dependent, was covered on NPH QAM and QPM with aspartate sliding scale for duration of hospitalization. The patient was restarted on Celexa per PCP for likely depressive mood response to recent bilateral knee amputation, and later started on Remeron 7.5 mg PO daily in place of Celexa. He was initially treated for urinary tract infection with uncomplicated course with ciprofloxacin, and Wound care nurse consulted for BKA wound and small decubitus on his back, was treated with DuoDERM, BKA site healing well. The patient was maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis during this hospitalization. He was discharged on Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Atrovent one to two puffs inhaled q.i.d. p.r.n. for wheezing, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, enteric-coated aspirin 325 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., therapeutic multivitamin one tablet p.o. daily, solsite topical, and instructed to follow up with psychiatry to assess depressive disorder/adjustment disorder, start beta-blocker at a low-dose in the outpatient setting, and check creatinine and BUN along with electrolytes to make sure patient is doing well on current maintenance diuretic schedule of 100 mg torsemide PO daily and spironolactone. Code status was full code.
|
Is there history of use of duoderm
|
{
"answer_end": [
2200
],
"answer_start": [
2123
],
"text": [
"small decubitus on his back, was treated with DuoDERM, BKA site healing well."
]
}
|
Ms. Leezer is a 50 year-old woman with a history of end stage renal disease, status post renal transplant, and a history of coronary artery disease, status post coronary artery bypass grafting. She had an episode of chest pain which was relieved by Nitroglycerin and passed out while saying goodbye to her husband, as well as several episodes of skipped heart beats during and after which she feels short of breath, and slurred speech for a few minutes. On admission her temperature was 98.8, pulse 96, blood pressure 120/70, and respirations 18. During her stay she was given a 250 cc fluid bolus, transfused two units of blood and her hematocrit went up to 31. Laboratory data revealed a sodium of 137, potassium 4.4, chloride 104, bicarbonate 15, BUN 86, creatinine 3.1, ALT 6, AST 11, alkaline phosphatase 44, bilirubin total 0.4, direct bilirubin 0.1, calcium 9.5, cholesterol 360, and HDL 40. An exercise tolerance test MIBI was performed, which was negative for ischemia, and the patient's ejection fraction was approximated to be 69%. Carotid noninvasives revealed moderate internal carotid plaque on the right and mild stenosis of the other arteries. An echocardiogram revealed concentric left ventricular hypertrophy with an ejection fraction of 65%. The patient was taken to Electrophysiology Study which revealed nonsustained ventricular tachycardia with possible right ventricular outflow tract origin. It was hoped that she could be maintained on Lopressor and Verapamil; however, her blood pressure did not tolerate the medication, so she was already on Atenolol for Beta blockade and Verapamil was tried. Her discharge medications included Aspirin 81 mg p.o. q. day, Vitamin C 100 mg p.o. q. day x14 days, Epogen 2,000 subcu q. week, Lasix 60 mg p.o. q. day, Gemfibrozil 300 mg p.o. b.i.d., Lisinopril 5 mg p.o. q. day, Prilosec 20 mg p.o. q. day, Prednisone 5 mg p.o. on even days, 10 mg p.o. on odd days, MVI with minerals one tablet p.o. q. day, Thiamine 50 mg p.o. b.i.d., Bicitra 15 ml p.o. b.i.d., Nephrocaps one tablet p.o. q. day, Cyclosporine 125 mg p.o. in the morning and 100 mg p.o. in the afternoon, Insulin sliding scale, Cellcept 1,000 mg p.o. b.i.d., and Prempro 0.625/0.25 mg p.o. q. day. Her triglycerides were checked during the hospitalization and found to be very high in the 1,500 range, so she was taken off Simvastatin and started on Gemfibrozil. She was discharged in stable condition the next day.
|
has there been a prior nephrocaps
|
{
"answer_end": [
2054
],
"answer_start": [
1993
],
"text": [
"Bicitra 15 ml p.o. b.i.d., Nephrocaps one tablet p.o. q. day,"
]
}
|
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.
|
What is the patient's current dose does the patient take of her hctz
|
{
"answer_end": [
580
],
"answer_start": [
542
],
"text": [
"enteric-coated aspirin 325 mg PO q.d.,"
]
}
|
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.
|
Why was cardiac medications prescribed
|
{
"answer_end": [
1113
],
"answer_start": [
1006
],
"text": [
"the patient continued her cardiac medications for BP control and ECG showed early R wave but no ST changes."
]
}
|
Mr. Wolfinbarger is a 55 year old male with Coronary Artery Disease who was admitted to Enreen Dallout Medical Center for cardiac catheterization. His Past Medical History includes non-Hodgkin's lymphoma, status bone marrow transplant and chemotherapy in 1992 and 1993; history of hypercholesterolemia, hypertension, insulin dependent diabetes, gastroesophageal reflux disorder and chronic renal insufficiency. He is allergic to Benadryl. His medications on admission included Toprol XL 200 mg q.d. Procardia XL 90 mg q.d, Lipitor 20 mg q.d., aspirin 325 mg q.d., Zantac 150 mg b.i.d., NPH humulin insulin 32 units each morning and 18 units each evening subcutaneously, Valium 5 mg q.d., Minipress 1 mg b.i.d. His physical examination was within normal limits, no varicosities. He underwent harvesting of the left radial artery for graft and a coronary artery bypass grafting x three with a left internal mammary artery to the left anterior descending coronary artery, saphenous vein graft from the posterior descending coronary artery to the aorta and a radial artery from the saphenous vein graft to the obtuse marginal coronary artery. Postoperatively, he had an episode of rapid atrial flutter and was chemically converted to sinus rhythm with Corvert and has remained in sinus rhythm on Lopressor and diltiazem for 24 hours. His saphenous vein harvest site showed some slight erythema to be treated with antibiotics by mouth. He is discharged on Axid 150 mg b.i.d, Lipitor 20 mg q.d., NPH Humulin insulin 32 Units every morning, 18 Units every evening; Diltiazem 60 mg t.i.d., Lopressor 150 mg b.i.d., enteric coated aspirin 125 mg once a day, Valium 5 mg once a day, Keflex 500 mg four times a day for 7 days, Percocet 1 to 2 tablets every four hours as needed for pain.
|
Why was the patient on diltiazem
|
{
"answer_end": [
1242
],
"answer_start": [
1139
],
"text": [
"Postoperatively, he had an episode of rapid atrial flutter and was chemically converted to sinus rhythm"
]
}
|
GVERRERO , STAN O 346-21-49-8, a 74 yo woman in remission from Hodgkin's Lymphoma and s/p renal transplant( 11/12 ), was discharged to Home with the attending physician being KERSON , RODNEY S , M.D. and code status being Full code. She was prescribed FESO4 ( FERROUS SULFATE ) 300 MG PO BID, FOLATE ( FOLIC ACID ) 1 MG PO QD, SYNTHROID ( LEVOTHYROXINE SODIUM ) 100 MCG PO QD, PREDNISONE 5 MG PO QAM, ZOCOR ( SIMVASTATIN ) 20 MG PO QHS, NEORAL ( CYCLOSPORINE MICRO ( NEORAL ) ) 100 MG PO BID, LOSARTAN 50 MG PO QD, ATENOLOL 25 MG PO QD, PRILOSEC ( OMEPRAZOLE ) 20 MG PO QD, AMIODARONE 400 MG PO BID, ECASA ( ASPIRIN ENTERIC COATED ) 325 MG PO QD, FLAGYL ( METRONIDAZOLE ) 500 MG PO TID X 2 Days, LEVOFLOXACIN 500 MG PO QD X 2 Days, and DIET: House / Low chol/low sat. fat with instructions for regular exercise and follow up with Dr. Schultheiss ( cardiology ) 5/30/03 scheduled. On order for NEORAL PO ( ref # 55336954 ) with a POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & CYCLOSPORINE override added on 11/0/03 by LIU , HERMAN ANTONIO , M.D., and LOSARTAN PO ( ref # 04133525 ) with a POTENTIALLY SERIOUS INTERACTION: CYCLOSPORINE & LOSARTAN POTASSIUM override added on 11/0/03 by ELVEY , EDMUND LENNY , M.D., Alert overridden: Override added on 5/27/03 by : POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & AMIODARONE HCL Reason for override: aware and POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & LEVOFLOXACIN Reason for override: aware. The patient had a hypoxic episode and EKG changes resolved, requiring 2u PRBCs, and was initially treated with lopressor 5mg IV, eventually rate controlled with dilt drip. PFT's , LFT's and TFT's were completed prior to discharge, and she was instructed to restart ecasa 5d p colonoscopy, as well as to take levofloxacin and flagyl for 5 days, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. Consider anticoagulation for PAF was recommended. On 1/16 she had Afib with RVR to 130s with chest arm pain which is her anginal equivalent. ECG with rate related ischemia ST depression V5-6, L. +Minimal troponin leak to 0.19, which subseq downtrended with nl CK. She was init treated with lopressor 5mg IV but had hypotension to 80's which resolved quickly with IVF. She was eventually rate controlled with dilt drip. She returned to sinus rhythm within the day. Cards c/s'd and recommended amio load. CXR showed no infiltrate/opacity. Levo/Flagyl given empirically x 5days though she remained afeb. Abdominal exam was concerning for focal peritoneal irritation. Her exam improved, and she was tolerating PO well at the time of discharge. She has been afeb and well appearing for several days prior to d/c. Plan to complete 5d abx. As per Dr. Thorburn her colonoscopy was complex, and she had polypectomy of 2.5 cm polyp. Path is pending. If + for cancer, the base looked "clean", so may be feasible to re-scope her for surveillance at a later time, as per GI. Hct after colonoscopy went to 24 ( baseline 30 ); post-transfusion HCt of 30.
|
Is there a mention of of prilosec ( omeprazole ) usage/prescription in the record
|
{
"answer_end": [
573
],
"answer_start": [
537
],
"text": [
"PRILOSEC ( OMEPRAZOLE ) 20 MG PO QD,"
]
}
|
The patient is a 70 year old white female with a history of long standing hypertension, hypercholesterolemia, and history of tobacco use who presented upon transfer from Ra Memorial Hospital with chief complaint of post MI unstable angina. She had a history of long standing hypertension and had chest pain in the past including at least one previous episode of rule out MI. She was admitted on 22 of April to Hen Mo Gardensworth Sent Hospital with signs and symptoms consistent with acute MI and apparently received salvage therapy with IV Streptokinase and TPA. On 0 of August, the patient presented to Cooker View Home Hospital with an episode of heavy substernal chest pressure relieved with SL and topical nitrates, and her EKG showed no worrisome ischemic changes. She was transferred to CNMC on IV Heparin, IV Nitroglycerin at 140 micrograms per minute, IV Heparin drip, Lopressor, aspirin one a day, beta blockade and aspirin. She had several episodes of typical substernal chest pain with minimal exertion that were relieved with SL Nitroglycerin, and additional episodes of chest pain that were low in intensity but prolonged, each of these requiring several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was treated by the addition of a calcium channel blocker, and her admission labs showed hematocrit 34.2, WBC 6.7, platelets 159,000, PTT 50.0 on IV Heparin. Postcatheterization, the patient showed mild hypertension which was treated by the addition of a calcium channel blocker, and she was also diuresed for fluid overload. Prior to discharge, she had two additional episodes of chest pain that were low in intensity but prolonged. Each of these required several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was unlikely to be cardiac in origin and more likely represented either GI symptomatology or an anxiety reaction. The patient underwent an exercise treadmill test on the modified Bruce protocol which showed no evidence for ischemia. On discharge, she was prescribed Nifedipine XL 90 mg po q am, Lopressor 50 mg po b.i.d., Zantac 150 mg po q hs, aspirin 81 mg po q d, Serax 15 mg po q 6 h or q hs prn, and Nitroglycerin 1/150 grain q 5 minutes x 3 SL prn chest pain. She was discharged to home and is to follow up with her primary care physician, Dr. Gayle Demeritt, and her cardiologist, Dr. Mark Willians, at ACSH. ALLERGIES: Penicillin which causes anaphylaxis. The patient is a 70 year old white female who had a history of long standing hypertension, hypercholesterolemia, and history of tobacco use and presented upon transfer from Ra Memorial Hospital with chief complaint of post MI unstable angina. She was admitted on 22 of April to Hen Mo Gardensworth Sent Hospital and apparently received salvage therapy with IV Streptokinase and TPA. On 0 of August, she presented to Cooker View Home Hospital with an episode of heavy substernal chest pressure relieved with SL and topical nitrates, and her EKG showed no worrisome ischemic changes. Upon transfer to CNMC, she was without chest pain and was given IV Nitroglycerin at 140 micrograms per minute, IV Heparin drip, Lopressor, aspirin one a day, beta blockade and aspirin. She had several episodes of typical substernal chest pain with minimal exertion that were relieved with SL Nitroglycerin, and additional episodes of chest pain that were low in intensity but prolonged, each of these requiring several Nitroglycerins and antacids to be relieved. Her admission labs showed hematocrit 34.2, WBC 6.7, platelets 159,000, PTT 50.0 on IV Heparin. Postcatheterization, the patient showed mild hypertension which was treated by the addition of a calcium channel blocker, and she was also diuresed for fluid overload. Prior to discharge, she had two additional episodes of chest pain that were low in intensity but prolonged. Each of these required several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was unlikely to be cardiac in origin and more likely represented either GI symptomatology or an anxiety reaction. The patient underwent an exercise treadmill test on the modified Bruce protocol which showed no evidence for ischemia. On discharge, she was prescribed Nifedipine XL 90 mg po q am, Lopressor 50 mg po b.i.d., Zantac 150 mg po q hs, aspirin 81 mg po q d, Serax 15 mg po q 6 h or q hs prn, and Nitroglycer
|
Has the patient had previous streptokinase
|
{
"answer_end": [
563
],
"answer_start": [
497
],
"text": [
"apparently received salvage therapy with IV Streptokinase and TPA."
]
}
|
A 73-year-old male patient with a history of coronary artery disease, ischemic cardiomyopathy, and valvular heart disease was admitted to the Rose-le Medical Center with a large left foot toe ulcer that was nonhealing, and signs and symptoms of decompensated heart failure and acute on chronic renal failure. During his stay, he was treated with Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Colace 100 mg p.o. b.i.d., insulin NPH 7 units q.a.m. and 3 units q.p.m. subcutaneously, Atrovent HFA inhaler 2 puffs inhaled q.i.d. p.r.n. for wheezing, magnesium gluconate sliding scale p.o. daily, oxycodone 5-10 mg p.o. q. 4h. p.r.n. pain, senna tablets one to two tablets p.o. b.i.d. p.r.n. constipation, spironolactone 25 mg p.o. daily, Coumadin 1 mg p.o. every other day, multivitamin therapeutic one tablet p.o. daily, Zocor 40 mg p.o. daily, torsemide 100 mg p.o. daily, OxyContin 10 mg p.o. b.i.d., Cozaar 25 mg p.o. daily, Remeron 7.5 mg p.o. q.h.s., and aspartate insulin sliding scale, as well as being maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., solsite topical, and 25 mg of hydrochlorothiazide b.i.d. 30 minutes prior to meals, in addition to ciprofloxacin, DuoDERM, BKA site healing with continued aspirin, and inhaled ipratropium. Hyponatremia due to heart failure was improved with diuresis, and the patient was maintained on Coumadin with an INR goal of 2-3, adjusted to 1 mg PO every other day. Diabetes mellitus, insulin-dependent, was covered on NPH QAM and QPM with aspartate sliding scale for duration of hospitalization. The patient was restarted on Celexa per PCP for likely depressive mood response to recent bilateral knee amputation, and later started on Remeron 7.5 mg PO daily in place of Celexa. He was initially treated for urinary tract infection with uncomplicated course with ciprofloxacin, and Wound care nurse consulted for BKA wound and small decubitus on his back, was treated with DuoDERM, BKA site healing well. The patient was maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis during this hospitalization. He was discharged on Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Atrovent one to two puffs inhaled q.i.d. p.r.n. for wheezing, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, enteric-coated aspirin 325 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., therapeutic multivitamin one tablet p.o. daily, solsite topical, and instructed to follow up with psychiatry to assess depressive disorder/adjustment disorder, start beta-blocker at a low-dose in the outpatient setting, and check creatinine and BUN along with electrolytes to make sure patient is doing well on current maintenance diuretic schedule of 100 mg torsemide PO daily and spironolactone. Code status was full code.
|
What is the dosage of beta-blocker
|
{
"answer_end": [
2934
],
"answer_start": [
2875
],
"text": [
"start beta-blocker at a low-dose in the outpatient setting,"
]
}
|
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty.
|
Has the patient had nph in the past
|
{
"answer_end": [
1017
],
"answer_start": [
953
],
"text": [
"her dose of NPH up to 65 U subcu b.i.d. on the day of discharge,"
]
}
|
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 a mention of of zantac usage/prescription in the record
|
{
"answer_end": [
410
],
"answer_start": [
347
],
"text": [
"was changed to bid on second hospital day, Zantac, and Lovenox."
]
}
|
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.
|
What medications did the patient take for constipation.
|
{
"answer_end": [
1602
],
"answer_start": [
1513
],
"text": [
"and to continue stool softeners for constipation and resume all home meds upon discharge."
]
}
|
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 the reason this patient is on oxycodone
|
{
"answer_end": [
1299
],
"answer_start": [
1263
],
"text": [
"oxycodone 5-10 mg q.4h. p.r.n. pain."
]
}
|
The patient is a 54 year old white male with cardiac risk factors of diabetes, borderline hypertension, male gender, and a positive family history, who presented to Leyson Memorial Hospital complaining of substernal chest pain. On arrival to Icoson Hospital, the patient's blood pressure was 126/80 and heart rate was 80, and the electrocardiogram showed new ST depressions in V2-V5, T wave inversions in AVL, and flat T's in 1 and V6. The patient was treated with two sublingual nitroglycerins and sent to the Mendwood Hospital. On route to Icoson Hospital, the patient received an aspirin, a sublingual nitroglycerin, nitro paste, Lopressor 5 mg x 1 intravenously, and intravenous heparin. Upon transfer to the CCU, the patient was pain free and was maintained on heparin and intravenous nitroglycerin for 72 hours after admission. The patient was started on Lopressor and Glucotrol 5 mg p.o. q.d., as well as enteric-coated aspirin at admission, and was maintained on his glipizide and atenolol, 50 mg p.o. q.d., and enteric-coated aspirin, as well as nitroglycerins p.r.n. chest pain. Two days after the cardiac catheterization, the patient was pain free and was maintained on heparin overnight. The patient's condition at the time of discharge was stable, and was discharged with diabetic teaching as an outpatient with CH, follow-up with Dr. Kalert, atenolol 50 mg PO q.d., sublingual nitroglycerins PRN chest pain, and Glucotrol 5 mg PO q.d.
|
Has this patient ever tried nitroglycerin sprays.
|
{
"answer_end": [
529
],
"answer_start": [
436
],
"text": [
"The patient was treated with two sublingual nitroglycerins and sent to the Mendwood Hospital."
]
}
|
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.
|
Has the patient ever had plavix ( clopidogrel )
|
{
"answer_end": [
631
],
"answer_start": [
595
],
"text": [
"Plavix (Clopidogrel) 75 mg PO daily,"
]
}
|
Loyd O. Karpinsky underwent a laparoscopic adjustable gastric band placement without complication and was transferred to the PACU in stable condition. Her pain was well controlled with PCA analgesia on POD0 and transitioned to po elixir analgesia following a negative upper GI study exhibiting no leaks. She was discharged on LANTUS (INSULIN GLARGINE) 10 UNITS SC QD, RANITIDINE HCL SYRUP 150 MG PO BID, ROXICET ELIXIR (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain, COLACE (DOCUSATE SODIUM) 100 MG PO TID HOLD IF: diarrhea, PHENERGAN (PROMETHAZINE HCL) 25 MG PR Q6H PRN Nausea, and AUGMENTIN SUSP. 250MG/62.5 MG (5ML) (AMOXICIL...) 10 MILLILITERS PO TID Instructions: for five days. At the time of discharge, her pain was well controlled and she was tolerating a stage 2 diet, afebrile, and all incisions were clean dry and intact. She was instructed to take the medications without regard to meals and to resume regular exercise, walking as tolerated. She was also to follow up with Dr. Hinsley in 1-2 weeks and Diabetes Management Service in 3 weeks, and to avoid strenuous activity, swimming, bathing, hot tubbing, and driving or drinking alcohol while taking prescription narcotic (pain) medications.
|
Has a patient had phenergan ( promethazine hcl )
|
{
"answer_end": [
588
],
"answer_start": [
535
],
"text": [
"PHENERGAN (PROMETHAZINE HCL) 25 MG PR Q6H PRN Nausea,"
]
}
|
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
|
zinc
|
{
"answer_end": [
1809
],
"answer_start": [
1752
],
"text": [
"Zinc and Vitamin C was started per the Nutrition consult."
]
}
|
The patient is a 68 year old female with a history of long standing hypertension and diabetes who experienced an increase in shortness of breath, dyspnea on exertion and paroxysmal nocturnal dyspnea while in Tempefayscot, Michigan 76498. She was admitted to the Short Stay Unit for evaluation with a systolic blood pressure greater than 200, and was administered Procardia XL 20 mg p.o. x 1, Aspirin, Nitropaste, and IV Lasix, to which she had a significant response. Her past medical history includes a stress echocardiogram which showed mitral regurgitation, hypokinesis of the septum and AV block on exertion with an ejection fraction of about 40%. On admission, she was taking Cardura, Vasotec, and Metoprolol. Her electrocardiogram showed bradycardia at 40 with a left bundle branch pattern and she had 2:1 AV block. Her chest x-ray showed an enlarged heart with pleural effusions and cephalization, and her laboratory data SMA-7 was within normal limits. She underwent pacemaker placement without any difficulty and it was interrogated the day after placement without any problem. She was discharged in stable condition with no reportable disease and no adverse drug reactions on Keflex 250 mg p.o. q.i.d. for 5 days; Norvasc 5 mg p.o. qd; Hydrochlorothiazide 25 mg p.o. qd and Vasotec 20 mg p.o. b.i.d. She will follow-up with her Cardiologist in one week and will probably have her blood pressure medications further adjusted at that point.
|
Has the patient had cardura in the past
|
{
"answer_end": [
714
],
"answer_start": [
666
],
"text": [
"she was taking Cardura, Vasotec, and Metoprolol."
]
}
|
A 83-year-old male patient with a history of CAD, IMI, CABG (2000), HTN, and BPH presented with sore throat, cough, and weakness, and was admitted to a medical service with a diagnosis of viral syndrome. He had an EKG showing A-paced at 69, IMI, normal axis, and no acute ischemic changes, a MIBI showing an EF of 45% and multiple pulmonary nodules, a CXR was negative, and a CT Chest showed several pulmonary nodules in RUL inferiorly, the largest being 0.6cm, and other tiny nodules in the upper lobes bilaterally, 2-3mm, and several small nodes in the mediastinum with no LAD. CTAB, RRR were normal. He was given TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, CEPACOL 1-2 Lozenge PO Q4H PRN Other:sore throat, Vitamin B12 (Cyanocobalamin) 1,000 mcg IM QD x 3 doses, Dipyridamole 25 mg PO QPM, Lasix (Furosemide) 10 mg PO QD, Isordil (Isosorbide Dinitrate) 30 mg PO TID, Ativan (Lorazepam) 3.5 mg PO QHS PRN Insomnia, Inderal (Propranolol HCl) 10 mg PO QID, Norvasc (Amlodipine) 2.5 mg PO QD, Nitroglycerin 0.2% Topical TP BID Instructions: 1 inch, Zetia (Ezetimibe) 10 mg PO QD, Azithromycin 500 mg pack 500 mg PO QD x 4 doses, and Calcium Phosphate, Oral, Reason for override: aware. He had no significant fever or WBC and his symptoms improved on admission with no cough. He was observed O/N with IVF and improved in the morning and will be D/C'd on Azithromycin x 5 days. For the pulmonary nodules, he will follow-up with Dr. Muether as an outpatient for w/u. For Heme, he was given anemia, iron studies, B12, and folate sent and got B12 1000ug IM x 1 and was instructed to follow-up with the doctor's office to get injections for 2 more days, then monthly, likely due to a gastrectomy. He was given instructions to continue TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, CEPACOL 1-2 Lozenge PO Q4H PRN Other:sore throat, Ativan (Lorazepam) 3.5 mg PO QHS PRN Insomnia, Azithromycin 500 mg pack 500 mg PO QD x 4 days, B12 1000ug QD for 2 more days, then qmonth, and to call his doctor if he continues to feel unwell or returns to the hospital, and to go to the doctor's office on Thursday and Friday to receive the B12 injections. He was discharged in a stable condition.
|
Has the patient had previous inderal ( propranolol hcl )
|
{
"answer_end": [
964
],
"answer_start": [
925
],
"text": [
"Inderal (Propranolol HCl) 10 mg PO QID,"
]
}
|
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 the patient had bb
|
{
"answer_end": [
1568
],
"answer_start": [
1495
],
"text": [
"added hydralazine/isordil for CAD, hyperlipidemia: BB, ACEI, statin, ASA;"
]
}
|
The patient was a 46 year old woman with a history of asthma who was admitted with an asthma exacerbation. She had asthma since childhood and was never intubated nor previously treated with steroids. On admission, her physical examination showed wheezes bilaterally in the lungs. Her laboratory examination showed hematocrit of 41.6, white count of 9.66, and platelets of 199,000. She was treated with steroids, Solu-Medrol and then prednisone 60 milligrams orally, beta agonist, nebulizer and ampicillin, and continued her oral theophylline as she had been using as an outpatient. Her medications on admission were Theo-Dur 200 milligrams by mouth 3 times a day, prednisone 60 milligrams by mouth each day, Albuterol nebulizer, ampicillin 500 milligrams by mouth 3 times a day and Bronkosol. Allergies included sulfa drugs. She slowly improved with decreased wheezing in her breath sounds and increased peak flow from 300. She was discharged on May 3rd with all her usual medications, plus Keflex 500 milligrams by mouth 4 times a day and prednisone 50 milligrams by mouth each day, and was to follow up with her doctor.
|
has the patient had theophylline
|
{
"answer_end": [
581
],
"answer_start": [
510
],
"text": [
"continued her oral theophylline as she had been using as an outpatient."
]
}
|
Mr. Legions is a 54 year old professor who presented to Menjack Hospital Medical Center with recurrent substernal chest pain one day after coronary artery bypass graft (5 vessel bypass) 8 years ago. His coronary risk factors include a positive family history and a previous diagnosis of hyperlipidemia. He was given Lovastatin 40 mg q q.m. and 20 mg q p.m., as well as enteric-coated aspirin one tablet q day. At Skaggssin Hospital, he was given IV nitroglycerin, IV heparin, Nifedipine SL, and morphine, in addition to aspirin and Lovastatin. The patient's pain was relieved with four sublingual nitroglycerin and an EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. He was treated symptomatically with Tylenol and started on Biaxin 500 mg po bid, and also received a five day course of oral Biaxin with Cholestyramine one packet po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn. The patient had episodes of fever, achieving a maximum temperature of 101.4, and a chest x-ray on 0/26/95 demonstrated evidence of early congestive heart failure. The patient was treated with daily doses of IV Lasix with resolution of his rales. He was admitted to the Cardiac Intensive Care Unit on IV heparin and nitroglycerine as well as continuation of his aspirin and Lovastatin. His pain was treated with morphine sulfate and relieved with four sublingual nitroglycerin. An EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. After 24 hours pain-free, the patient was transferred to the Cardiac Step-Down floor and the IV nitroglycerin and IV heparin were discontinued. An echocardiogram demonstrated inferior and posterior hypokinesis with an ejection fraction of approximately 46%, and the patient underwent a submax MIBI to assess coronary perfusion of the heart. The exercise component of this examination demonstrated EKG changes consistent with ischemic coronary flow. Nuclear imaging demonstrated a fixed apical lateral defect in the patient's heart consistent with a healed or healing transmural infarct. The patient also complained of progressive anterior and lateral thigh pain, symptoms consistent with an upper respiratory viral infection, and rales 4 to 5 cm above the bases bilaterally. He was discharged to home with followup in MERH under Drs. Dwayne Ariel Bremme with the medications Enteric-coated aspirin 325 mg po q day, Cholestyramine one packet po q hs, Lovastatin 20 mg po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn with chest pain.
|
What medications has this patient tried for temperature
|
{
"answer_end": [
776
],
"answer_start": [
695
],
"text": [
" He was treated symptomatically with Tylenol and started on Biaxin 500 mg po bid,"
]
}
|
The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg
|
Has the patient had multiple depakote prescriptions
|
{
"answer_end": [
1282
],
"answer_start": [
1202
],
"text": [
"PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily,"
]
}
|
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o.
|
What anticoagulation meds has vet tried in past
|
{
"answer_end": [
578
],
"answer_start": [
525
],
"text": [
"heparin while starting anticoagulation with Coumadin."
]
}
|
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.
|
What is the patient's current dose does the patient take of her valsartan
|
{
"answer_end": [
2340
],
"answer_start": [
2314
],
"text": [
"Valsartan 160 mg p.o. q.d."
]
}
|
Patient Isaac Vanover, Jr., a 44-year-old man with a history of CAD s/p MI x2 4/14 with PCI, in stent thrombosis, and re-stenting, was admitted multiple times for CP with associated fatigue and SOB. He was placed on ECASA (Aspirin Enteric Coated) 325 MG PO QD, COLACE (Docusate Sodium) 100 MG PO BID PRN constipation, ENALAPRIL MALEATE 5 MG PO QAM HOLD IF: SBP<100, POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & ENALAPRIL MALEATE (on order for KCL IMMEDIATE RELEASE PO (ref #56599393)), ATIVAN (Lorazepam) 1 MG PO TID Starting Today March PRN anxiety HOLD IF: RR<12 or pt is lethargic, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain HOLD IF: SBP < 100, ZOLOFT (Sertraline) 100 MG PO QD, ZOCOR (Simvastatin) 20 MG PO QHS, PLAVIX (Clopidogrel) 75 MG PO QD, VIOXX (Rofecoxib) 25 MG PO QD, ZANTAC (Ranitidine HCl) 150 MG PO BID PRN dyspepsia, and ATENOLOL 25 MG PO QD with Food/Drug Interaction Instruction. Managed on Hep, TNG gtt, Plavix, ACE, B blocker, and Demerol, the pain recurred and he was transferred to BVH for cath. Cardiac catheterization on 8/18/02 showed non-obstructive CAD with LMCA, LAD, LCx, and RCA all OK. Pulmonary level of suspicion for PE is low, so D-dimer is sent and PE ruled out. Mild fluid overload was managed with Lasix to keep I/O's 500-1000cc neg. Pain could represent pericarditis, but psychiatric etiology for CP becomes more likely and psychiatric follow-up and treatment for anxiety and depression is recommended. WBC count increased 4/10 but no other sign/symptom of infection, CXR showed no infiltrates, and the patient was discharged stable with instructions to schedule an appointment with the primary doctor within 2-4 weeks, and if chest pain changes in character or is associated with new symptoms, the patient is to notify their doctor or call 911.
|
Has the patient ever had demerol
|
{
"answer_end": [
965
],
"answer_start": [
928
],
"text": [
"Managed on Hep, TNG gtt, Plavix, ACE,"
]
}
|
Patient Omar J. Coolbaugh, a 71-year-old female post cardiac transplant with allograft coronary artery disease, bilateral carotid disease, TIA, diabetes, and obesity, was admitted on 11/8/2007 and discharged on 4/14/2007 with s/p angioplasty and stenting. The medications on admission included Mycophenolate Mofetil 1000 mg PO BID, Oxybutynin Chloride XL 10 mg PO QD, Insulin Glargine 20 units SC QAM, Furosemide PO QD, Clopidogrel 75 mg PO QD, Pravastatin 40 mg PO QHS, Prednisone 5 mg PO QD, Cyclosporine (Sandimmune) 75 mg PO BID, Metoprolol Succinate Extended Release 50 mg PO QD, and Fenofibrate (Tricor) 48 mg PO QD. Elective cardiac catheterization was performed, revealing double vessel disease and successful PTCA/Stenting of LAD was done using XB3.5 guide, BMW, with no residual stenosis. The patient was advised to take Enteric Coated ASA 325 mg PO Daily, Plavix (Clopidogrel) 75 mg PO Daily, Cyclosporine (Sandimmune) 75 mg PO BID, Tricor (Fenofibrate (Tricor)) 48 mg PO Daily, Lasix (Furosemide) 40 mg PO Daily, Insulin Glargine 20 units SC Daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO Daily, CellCept (Mycophenolate Mofetil) 1,000 mg PO BID, Ditropan XL (Oxybutynin Chloride XL) 10 mg PO Daily, Pravachol (Pravastatin) 40 mg PO Bedtime, Prednisolone Sodium Phosphate 5mg/5ml 5 mg PO Daily, and vitamins, with ASA 325 and Plavix for life and other medications at usual doses, plus TNG 0.4 mg (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 doses PRN Chest Pain. The importance of both aspirin and taking medications consistently was stressed and the patient understands, with diet house/low chol/low sat. fat and activity light activity with no heavy lifting or driving x 2 days, ok to shower, no swimming or bathing x 5 days and lift restrictions of not lifting greater then 10-15 pounds. Follow up appointments were scheduled for Heart Failure Clinic 2-4 weeks and patient was discharged in stable condition and advised to drink plenty of fluids over the next several days, and to call with any questions or concerns.
|
has the patient had other medications
|
{
"answer_end": [
1409
],
"answer_start": [
1376
],
"text": [
"other medications at usual doses,"
]
}
|
The 68-year-old female patient presented with lower extremity swelling and erythema at the lower pole of her sternal wound, and her past medical history includes hypertension, diabetes, hypothyroidism, hypercholesterolemia, COPD, GERD, depression, history of GI bleed on Coumadin therapy, and pulmonary hypertension. On admission, the patient was started on 1. Toprol 25 p.o. daily., 2. Valsartan 40 mg p.o. daily., 3. Aspirin 81 mg p.o. daily., 4. Plavix 75 mg p.o. daily., 6. Lasix 40 mg p.o. b.i.d., 7. Spironolactone 25 mg p.o. daily., 8. Simvastatin 20 mg p.o. daily., 9. Nortriptyline 50 mg p.o. daily., 10. Fluoxetine 20 mg p.o. daily., 11. Synthroid 88 mcg p.o. daily., and a Lasix drip and Diuril with antibiotics for coverage of possible lower extremity cellulitis. After transthoracic echocardiogram revealed an ejection fraction of 40% to 45% and a stable mitral valve, the patient was started on a Lasix drip and Diuril with improvement of symptoms, and the Pulmonary team was consulted and recommended regimen of Advair and steroid taper for her COPD, and she was empirically covered for pneumonia with levofloxacin and Flagyl and continued to diurese well on a Lasix drip. Her preadmission cardiac meds, as well as her Coumadin for atrial fibrillation, were restarted, and the patient required ongoing aggressive diuresis to eventually achieve a fluid balance of is negative 1 liter daily. Liver function tests, as well as amylase and lipase, were checked and noted to be normal, and the patient's nausea and vomiting resolved when her bowels began to move. The patient was discharged to home in good condition on hospital day #8 with medications including Enteric-coated aspirin 81 mg p.o. daily, Zetia 10 mg p.o. daily, Fluoxetine 20 mg p.o. daily, Advair Diskus one puff nebulized b.i.d., Lasix 60 mg p.o. b.i.d., NPH insulin 30 units subcutaneously q.p.m., NPH insulin 20 units subcutaneously q.a.m., Potassium slow release 30 mEq p.o. daily, Levofloxacin 500 mg p.o. q.24 h. x4 doses, Levothyroxine 88 mcg p.o. daily, Toprol-XL 100 mg p.o. daily, Nortriptyline 50 mg p.o. nightly, Prednisone taper 30 mg q.24 h. x3 doses, 20 mg q.24 h. x3 doses followed by a 10 mg q.24 h. x3 doses, then 5 mg q.24 h. x3 doses, Simvastatin 40 mg p.o. nightly, Diovan 20 mg p.o. daily, and Coumadin to be taken as directed to maintain INR 2 to 2.5 for atrial fibrillation, with followup appointments with her cardiologist, Dr. Schwarzkopf in one to two weeks with her cardiac surgeon, Dr. Carlough in four to six weeks, and VNA will monitor her vital signs, weight, and wounds, and the patient's INR and Coumadin dosing will be followed by S Community Hospital Anticoagulation Service at 300-135-5841.
|
Has patient ever been prescribed enteric-coated aspirin
|
{
"answer_end": [
1712
],
"answer_start": [
1672
],
"text": [
"Enteric-coated aspirin 81 mg p.o. 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.
|
What medicines have previously been tried for her typical anginal symptoms
|
{
"answer_end": [
411
],
"answer_start": [
335
],
"text": [
"The patient was given three sublingual Nitroglycerins after her primary M.D."
]
}
|
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
|
Is there a mention of of antibiotics usage/prescription in the record
|
{
"answer_end": [
1654
],
"answer_start": [
1590
],
"text": [
"Continue your antibiotics as long as you have a drain in place.,"
]
}
|
Ms. Watterson, a 75 year old female with a history of CHF/CAD, A-fib, lung CA s/p R wedge resection, basal cell CA on lip s/p resection, and uterine CA s/p TAH, was admitted to the hospital with increasing SOB, weight gain, orthopnea, fever, chills, decreased UOP x1-2 days, L leg swelling, and a T98.6, P72, BP121/65, RR18. In the ED she was given O2 and 40mg of Lasix IV, and her daily meds included Acetylsalicylic Acid 325mg PO daily, Allopurinol 100mg PO daily, Docusate Sodium 100mg PO BID, Esomeprazole 20mg PO daily, Ferrous Sulfate 325mg PO TID, Glipizide 5mg PO BID, KCL Slow Release 20MEQ PO BID, Levothyroxine Sodium 100mcg PO daily, Lorazepam 0.5mg PO daily PRN Insomnia/Anxiety, Metolazone 2.5mg PO daily, Metoprolol Succinate Extended Release 100mg PO daily, Multivitamins 1tab PO daily, Pravastatin 40mg PO bedtime, Torsemide 20mg PO BID, and Warfarin Sodium 2mg PO QPM. CXR, diuresis with IV medications, EKG, R/O MI, and Abdo CT were performed and the patient improved clinically. Antibiotics such as Azithromycin and Levofloxacin were initiated for PNA, and Cefpodoxime 200mg PO QD x 7 days was added for gram pos coverage. In addition, she was given Tessalon Perels 100mg PO TID PRN cough, Guiatuss 10ml PO Q4H PRN cough, Loperamide 2mg PO Q6H PRN diarrhea, and Metolazone 2.5mg PO daily PRN weight gain. The patient was supertheraputic on Coumadin and it was held throughout her admission, INR remained 3.9 to 4.0 in the setting of hemoptysis, started on 1/2 her home coumadin with VNA/PCP f/u in 2 days, d/ced on Coumadin 1mg qpm, UA and urine CTX were negative, developed diarrhea concerning for c.diff but had only been on azithromycin x1 day, all stool studies were negative, presumed viral gastroenteritis, started on loperamide before discharge to be continued prn diarrhea, pt's po DM rx were held during her admission covered with Lantus and Insulin Asp SS, HgA1c was sent and was in nl range, home po rx were restarted on discharge, kept on her home dose of levoxyl, TSH was rechecked and within nl range, home po rx Allopurinol was also continued, the following antibiotics were added: Levofloxacin 500mg by mouth every 48 hours for 7 days, Cefpodoxime 200mg by mouth once daily for 7 days, Tessalon Perels 100mg by mouth three times daily as needed for cough, Guiatuss 10ml by mouth every 4 hours as needed for cough, Loperamide 2mg by mouth every 6 hours as needed for diarrhea, Coumadin: Were taking 2mg by mouth in the pm, now take 1mg by mouth in the pm, and instructions, pt took Metolazone 2.5mg and Torsamide 40mg x1 which did. During her stay the patient remained in afib with good rate control on her bblocker, rx of betablocker, ASA, statin, was diuresed with IV Lasix in the ED, Metolazone 2.5mg and Torsamide 40mg x1, on 2/22 pt's weight increased to 72.9 kg from 70.6kg, restarted on her home rx of torsemide 20mg po bid, was roughly negative 1.3L, pt's daily weights decreased off diuretics, was found to be supertheraputic on her coumadin which was held throughout admission, PNA was initially treated with azithromycin but as her cough and o2 levels persisted, pt was begun on ceftaz and levo for gram pos coverage (levo) double gram neg coverage, and ceftaz changed to cefpodoxime 200mg po qd x 7 days, however pt had only been on azithromycin x 1 day, all stool studies were negative, presumed viral gastroenteritis
|
Has this patient ever been treated with loperamide hcl
|
{
"answer_end": [
1277
],
"answer_start": [
1242
],
"text": [
"Loperamide 2mg PO Q6H PRN diarrhea,"
]
}
|
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.
|
Is there history of use of nph insulin
|
{
"answer_end": [
723
],
"answer_start": [
656
],
"text": [
"His current medications include NPH Insulin 32 units every morning,"
]
}
|
This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160
|
What is the current dose of the patient's nexium (esomeprazole)
|
{
"answer_end": [
2178
],
"answer_start": [
2144
],
"text": [
"Nexium (Esomeprazole) 20 mg PO QD,"
]
}
|
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage.
|
has there been a prior chemo
|
{
"answer_end": [
1311
],
"answer_start": [
1250
],
"text": [
"enteritis and recent chemo, she required multiple further RBC"
]
}
|
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