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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
|
pain meds on in past
|
{
"answer_end": [
2120
],
"answer_start": [
2066
],
"text": [
"DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain."
]
}
|
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
|
Previous milk of magnesia (magnesium hydroxide)
|
{
"answer_end": [
2015
],
"answer_start": [
1947
],
"text": [
"Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation,"
]
}
|
This 63-year-old male was transferred from LMC with a positive stress test and a history of CABG LIMA-D1, V-OM1, V-OM2, V Y-graft to PDA and PLV. Upon admission, he was diagnosed with CAD and presented with exertional angina. A nuclear stress revealed inferior scar and small area of anterior ischemia, and he was then transferred to CTMC for a cath. His medications on transfer included Dilantin 300/300/250, Glyburide 10 BID, Metformin 850 TID, Toprol 100 Daily, ASA 325 Daily, Isordil 20 TID, Lasix 20 QOD, Lipitor 40 Daily, Neurontin, Celondin 300 TID, Digoxin 0.25 Daily, and Benazepril 10 Daily. His hospital course included CV: Cath LIMA-LAD, DM: holding Metformin and restarting Glyburide and RISS, Neuro: Cont Neurontin 300 TID, Dilantin 200/200/250, and Celondin, and he was switched to Plavix 75 Daily, Atorva to Simva in house, Benazepril to Lisinopril 10, and Digoxin 0.25. He was discharged with instructions to take all medications as prescribed, with a full code status and disposition of Home. Medications at discharge included DIGOXIN 0.25 MG PO DAILY, LASIX (FUROSEMIDE) 20 MG PO EVERY OTHER DAY, GLYBURIDE 10 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, DILANTIN (PHENYTOIN) 200 MG QAM; 250 MG QPM PO BEDTIME, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 100 MG PO DAILY Food/Drug Interaction Instruction, NEURONTIN (GABAPENTIN) 300 MG PO TID, PLAVIX (CLOPIDOGREL) 75 MG PO DAILY, BENAZEPRIL 10 MG PO DAILY, GLUCOPHAGE (METFORMIN) 850 MG PO TID, and CELONTIN (METHSUXIMIDE) 300 MG PO TID.
|
What is the current dose of the patient's celondin
|
{
"answer_end": [
576
],
"answer_start": [
510
],
"text": [
"Lipitor 40 Daily, Neurontin, Celondin 300 TID, Digoxin 0.25 Daily,"
]
}
|
Patient DOUGLASS W. DILEO was admitted to CAR with unstable angina and discharged on 11/23/04 with a code status of full code and disposition of home w/ services. The patient has a possible allergy to NSAIDs with reaction unknown and a probable allergy to SIMVASTATIN, NSAIDs, SHELLFISH, and Codeine. The patient was given atropine and Fem stop placed over cath due to femoral hematoma. CT ruled out retroperitoneal bleed and her HCT dropped from 32 to 26, and she was transfused 2 U PRBC. The anti-ischemic regimen at discharge included ENTERIC COATED ASA (ASPIRIN ENTERIC COATED) PO 325 MG QD (ref #57541802), INSULIN NPH HUMAN 36 UNITS QAM; 40 UNITS QPM SC, NEURONTIN (GABAPENTIN) 600 MG PO BID, PLAVIX (CLOPIDOGREL) 75 MG PO QD, ZETIA (EZETIMIBE) 10 MG PO QD, LISINOPRIL 40 MG PO QD, HYDROCHLOROTHIAZIDE 25 MG PO QD, PREVACID (LANSOPRAZOLE) 30 MG PO QD, GLUCOPHAGE (METFORMIN) 1,000 MG PO BID, and ATENOLOL 25 MG PO QD, with no statin due to muscle pain history. The patient was instructed to take 1/2 their regular home dose of Atenolol until they see their cardiologist/PCP, and to follow a diet of house/low chol/low sat. fat and house/ADA 2100 cals/dy. Patient was to follow up with Dr. Brechbiel in 2 weeks and Dr. Damms for right leg ultrasound in 2-4 weeks. The patient also had a below-the knee right tibial vein DVT, was not anticoagulated for this below-the knee clot because of low risk of embolization and her recent HCT drop/hematoma. The patient was also given IBUPROFEN 600-800 MG PO Q6H PRN Pain for left knee pain after a fall one week prior. The patient was instructed to continue home diabetic regimen and followup with PCP/cardiology and schedule a repeat right leg ultrasound test (“LENI”) to follow the small blood clot in her leg in the future.
|
Is there history of use of enteric coated asa ( aspirin enteric coated )
|
{
"answer_end": [
594
],
"answer_start": [
538
],
"text": [
"ENTERIC COATED ASA (ASPIRIN ENTERIC COATED) PO 325 MG QD"
]
}
|
The patient is an 83-year-old female with a history of coronary artery bypass grafting (CABG) in 1993, a left main and diagonal percutaneous transluminal coronary angioplasty (PTCA) with cypher stent, and a bare metal stent in the diagonal for recurrent chest pain. She was admitted for possible myocardial infarction due to anginal pain, however 3 sets of negative cardiac enzymes and no EKG changes ruled this out. She woke up at 5am with substernal epigastric pain, which was unclear if it was angina or esophageal spasm. She took Maalox and 3 nitroglycerin (NTG) with pain that responded to nitro, blood pressure (BP) dropped 140s to 90s but came right back. Admitted medications included ECOTRIN (Aspirin Enteric Coated) 325 mg PO QD, Atenolol 50 mg PO QD, Ferro-Sequels 1 tab PO QD, Lisinopril 30 mg PO QD, Pravachol (Pravastatin) 80 mg PO QHS, Norvasc (Amlodipine) 5 mg PO QD, Imdur ER (Isosorbide Mononitrate (SR)) 120 mg PO QD, Pilocarpine 2% 1 drop OU BID, Bactrim DS (Trimethoprim/Sulfamethoxazole Double Strength) 1 tab PO BID x 12 doses starting today (10/19), Clobetasol Propionate 0.05% Cream TP BID, Allegra (Fexofenadine HCL) 60 mg PO QD, on order for Allegra PO (ref #483093734), Alphagan (Brimonidine Tartrate) 1 drop OU BID, Plavix (Clopidogrel) 75 mg PO QD, Calcium Carbonate 1,500 mg (600 mg elem Ca)/Vit D 200 IU 1 tab PO QD, Zetia (Ezetimibe) 10 mg PO QD, Metformin 250 mg PO BID, Aciphex (Rabeprazole) 20 mg PO QD, and Plavix, BB, ACE, statin, Zetia. Lipid panel was good with total cholesterol 163 and LDL 86 HDL 43. ACE was uptitrated to optimize BP, increased to 30 mg daily with improved BP with SBP in 110s. The patient had a history of anemia and was continued on iron. HCT was stable in low 30s, 32.6 at discharge. The patient was started on Bactrim for 7 days for a urinary tract infection. All other medications were the same. The patient was discharged in stable condition with instructions to monitor BP with uptitration of ACE, take calcium, follow a cardiac and diabetic diet, watch calcium, and take Lovenox and PPI.
|
Has the patient had ferro-sequels in the past
|
{
"answer_end": [
787
],
"answer_start": [
762
],
"text": [
"Ferro-Sequels 1 tab PO QD"
]
}
|
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure.
|
Why is the patient on magnesium
|
{
"answer_end": [
1220
],
"answer_start": [
1184
],
"text": [
"Magnesium oxide 280 milligrams q.d.,"
]
}
|
This is a 63-year-old female who presented with bilateral lower extremity edema, increasing shortness of breath, 3+ edema in the extremities, areas of erythematous and shiny shallow ulcerations, significant laboratory data of sodium 147, potassium 3.4, chloride 110, CO2 26, BUN 23, creatinine 1.6, and glucose 69, CBC significant for white count of 6.7, hematocrit 39.4, and platelets of 258, CK 432, troponin less than assay, BNP greater than assay, and D-dimer 50 and 69, chest x-ray showed decreased lung volumes with moderate cardiac enlargement, EKG showed sinus bradycardia with a rate of 59, axis of -36 and no acute changes. The patient has a history of congestive heart failure, deep venous thrombosis bilaterally with PE, acute renal failure, nephrotic syndrome, pneumonia, iron and folate deficiency anemia, paroxysmal atrial fibrillation with rapid ventricular response, nonsustained ventricular tachycardia, insulin-dependent diabetes mellitus, hypertension, cholesterol, chronic knee and back pain, arthroscopic knee surgery bilaterally, gastritis, benign colon polyps greater than 10, cataracts, and glaucoma. She was prescribed Lasix 120 mg p.o. b.i.d., Atenolol 50 mg p.o. q.d., Iron sulfate 300 b.i.d., Folate 1 mg q.d., NPH insulin 20 units q.d., Oxycodone 5 mg to 10 mg q.4-6h. p.r.n. pain., Senna, Multivitamins, Zocor 40 mg p.o. q.d., Norvasc 10 mg p.o. q.d., Accupril 80 mg p.o. q.d., Miconazole 2% topical b.i.d., Celexa 20 mg p.o. q.d., Avandia 8 mg p.o. q.d., Nexium 20 mg p.o. q.d., Albuterol p.r.n., aspirin as well as statin, a low-dose short-acting beta-blocker (Lopressor), an ACE inhibitor with this switched to captopril as a short-acting ACE inhibitor for a goal blood pressure of systolic of 120, an adenosine MIBI, runs of NSVT and Coumadin 5 mg p.o. q.h.s., folate and iron replacement, NPH 20 units for her known diabetes, Bactrim one tablet p.o. b.i.d. for 7 days, Celebrex and other antiinflammatory medications, Colace 100 mg p.o. b.i.d., Prozac 20 mg p.o. q.d., NPH human insulin 20 units subcu q.p.m., Zestril 30 mg p.o. q.d., Senna tablets 2 mg p.o. b.i.d., Aldactone 25 mg p.o. q.d., Multivitamins with minerals one tablet p.o. q.d., Toprol XL p.o. q.d., Imdur 30 mg p.o. q.d., Prednisolone acetate 0.125% one drop OU q.i.d., Albuterol inhaler 2 puffs inhaler q.i.d. p.r.n. wheezing., Miconazole nitrate powder topical b.i.d. p.r.n., Aspirin 81 mg p.o. q.d., and her creatinine continued to rise until 8/3/03, when it reached 2.7, diuresis was put on hold on 3/15/03 and 10/5/03, and her ACE inhibitor dose was halved on 10/5/03, in order to monitor her creatinine function, she was found to have a UTI with E. Coli that was sensitive to Bactrim and she was treated with Bactrim with resolution, for her chronic pain and arthritis, her Celebrex was held given her increased creatinine and she was given oxycodone p.r.n. for pain, joint exam revealed swollen PIP joints of both hands as well as marked swelling over both wrists, and an ANA test came back negative, she was continued on Celexa for depression, a goal INR of 2 to 3 was set for her Coumadin, which was restarted on 4/12/03 for known paroxys
|
Has patient ever been prescribed norvasc
|
{
"answer_end": [
1382
],
"answer_start": [
1358
],
"text": [
"Norvasc 10 mg p.o. q.d.,"
]
}
|
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.
|
What medicines have previously been tried for diabetes mellitus
|
{
"answer_end": [
1217
],
"answer_start": [
1143
],
"text": [
"The patient had not taken her insulin for several days prior to admission,"
]
}
|
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.
|
Is there history of use of cellcept
|
{
"answer_end": [
1024
],
"answer_start": [
1001
],
"text": [
"Cartia XT 300 mg daily,"
]
}
|
The patient is a 75-year-old male with a history of coronary artery disease, status post five catheterization with a pacemaker in place, arthritis, gout, benign prostatic hypertrophy, hypertension, and myelodysplasia who presented with a history of lower gastrointestinal bleeds. He was transfused with four units of packed red blood cells and then transferred to the Siter Calvty Valley Hospital for further evaluation and treatment. On admission, his hematocrit was 32.9 and subsequent serial hematocrits over the following two days were stable. A right hemicolectomy was performed on hospital day number three to prevent further episodes and the procedure and recovery were unremarkable. He was started on sips on postoperative day number one and clear liquids on postoperative day number two. He was advanced to a regular house diet on postoperative day number four and was discharged to home with services on the day of discharge. The patient was seen by his cardiologist, Dr. Poette throughout his hospitalization and was noted to have a run of V-tach 10 beats, asymptomatic, no chest pain or discomfort, no shortness of breath. He was discharged on Allopurinol 300 mg p.o. q.d., atenolol 25 mg p.o. q.d., Colace 100 mg p.o. b.i.d. p.r.n. constipation, Percocet 1-2 tablets p.o. q.4h. p.r.n. pain, Zantac 150 mg p.o. b.i.d., and Flomax 0.8 mg p.o. q.d. He will follow up with Dr. Weigold, his hematologist, in 2-4 weeks and Dr. Condiff on 8/28/02.
|
Has the patient had packed red blood cells in the past
|
{
"answer_end": [
339
],
"answer_start": [
280
],
"text": [
"He was transfused with four units of packed red blood cells"
]
}
|
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.
|
Why was the patient prescribed oxycodone
|
{
"answer_end": [
386
],
"answer_start": [
339
],
"text": [
"Oxycodone 5 mg to 10 mg p.o. q.4h. p.r.n. pain,"
]
}
|
A 66-year-old gentleman with a medical history significant for coronary artery disease and two prior MIs presented with substernal chest pain while walking that lasted 2-3 hours and was relieved by rest and sublingual nitroglycerin. He was admitted and cardiac catheterization revealed 90% proximal LAD stenosis, 90% mid LAD and 100% distal LAD stenosis, 100% mid LVB1, 80% mid circumflex, 70% proximal D1, 70% proximal PDA, and a right dominant circulation, with diffuse coronary calcification and extensive diffuse disease with small distal vessels. LAD in stent restenosis and collateral flow diffusely small left main. On 4/15/05, the patient underwent CABG x4 with SVG1 to RCA, and sequential graft of SVG2 to D1 and then OM1, with LIMA to LAD and an LAD endarterectomy. On arrival to the hospital, he was given 150 mg of Plavix, heparin 500 units for 48 hours, and aspirin that same night. He was also started on Enteric-coated aspirin 325 mg p.o. daily, atenolol 75 mg p.o. daily, Colace 100 mg p.o. t.i.d., oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n. pain, Plavix 75 mg p.o. daily, Lantus 38 units subcutaneously at bedtime, NovoLog 18 units subcutaneous q.a.m., and Lasix with good effect. He required the transfusion of a unit of packed red blood cells and neosynephrine transiently, which was weaned off on postoperative day #2. He was also noted to have a preoperative urinary tract infection of E. coli for which he was started on levofloxacin on 0/5/05 and treated for five days. The patient was followed by the Diabetes Management Service for blood sugar control and was transitioned from IV insulin to subcutaneous insulin postoperatively. He was discharged to home in good condition on postoperative day #7 on the following medications and is to have a follow-up appointment with his cardiologist, Dr. Abusufait, in one to two weeks, and with his cardiac surgeon, Dr. Cederberg, in four to six weeks.
|
What types of medications have been tried for a preoperative urinary tract infection management
|
{
"answer_end": [
1491
],
"answer_start": [
1442
],
"text": [
"levofloxacin on 0/5/05 and treated for five days."
]
}
|
A 66-year-old gentleman with a medical history significant for coronary artery disease and two prior MIs presented with substernal chest pain while walking that lasted 2-3 hours and was relieved by rest and sublingual nitroglycerin. He was admitted and cardiac catheterization revealed 90% proximal LAD stenosis, 90% mid LAD and 100% distal LAD stenosis, 100% mid LVB1, 80% mid circumflex, 70% proximal D1, 70% proximal PDA, and a right dominant circulation, with diffuse coronary calcification and extensive diffuse disease with small distal vessels. LAD in stent restenosis and collateral flow diffusely small left main. On 4/15/05, the patient underwent CABG x4 with SVG1 to RCA, and sequential graft of SVG2 to D1 and then OM1, with LIMA to LAD and an LAD endarterectomy. On arrival to the hospital, he was given 150 mg of Plavix, heparin 500 units for 48 hours, and aspirin that same night. He was also started on Enteric-coated aspirin 325 mg p.o. daily, atenolol 75 mg p.o. daily, Colace 100 mg p.o. t.i.d., oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n. pain, Plavix 75 mg p.o. daily, Lantus 38 units subcutaneously at bedtime, NovoLog 18 units subcutaneous q.a.m., and Lasix with good effect. He required the transfusion of a unit of packed red blood cells and neosynephrine transiently, which was weaned off on postoperative day #2. He was also noted to have a preoperative urinary tract infection of E. coli for which he was started on levofloxacin on 0/5/05 and treated for five days. The patient was followed by the Diabetes Management Service for blood sugar control and was transitioned from IV insulin to subcutaneous insulin postoperatively. He was discharged to home in good condition on postoperative day #7 on the following medications and is to have a follow-up appointment with his cardiologist, Dr. Abusufait, in one to two weeks, and with his cardiac surgeon, Dr. Cederberg, in four to six weeks.
|
What types of medications have been tried for pain management
|
{
"answer_end": [
1062
],
"answer_start": [
988
],
"text": [
"Colace 100 mg p.o. t.i.d., oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n. pain,"
]
}
|
The patient 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.
|
digoxin
|
{
"answer_end": [
375
],
"answer_start": [
315
],
"text": [
"Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg"
]
}
|
This is a 42 year old female nurse with morbid obesity who was admitted on 0/25/95 due to concern for her being at high risk of skin breakdown and infection. A panniculectomy was performed by Dr. Stanczyk without any complications. During the hospital course, the patient was treated with MEDICATIONS: Paxil, 60 mg P O q AM; Diabeta, 5 mg P O q AM; Trazadone, 100 mg q h.s.; Ultram, 100 mg q 4-6 hours prn; Reglan, 10 mg q 6 hours prn nausea; Bactroban ointment b.i.d.; Lotrisone cream b.i.d. topically; Afrin nasal spray q 12 hours PRN; Proventil inhalers, two puffs PRN; IV Ancef t.i.d.; Hibiclenz showers and sub-q Heparin. Preoperatively, her pulmonary function was assessed and found to have an FEV-1 of 53% of predicted; FVC of 57% of predicted and an FEV-1/FVC of 93% of predicted. Postoperatively, the patient was transferred to the ICU and received two (2) units of autologous red blood cells and two (2) units of blood with a hematocrit reaching 29%. On postoperative day five, two of the four Jackson-Pratt drains were removed and the patient was discharged in good condition on postoperative day six with plans for home visiting nurse for dressing changes daily and P O Keflex while two Jackson-Pratt drains were in. The patient was prescribed DISCHARGE MEDICATIONS: 1) Keflex, 500 mg P O q.i.d.; 2) Percocet one to two P O q 4 hours prn pain; 3) Lotrisone topically, TP b.i.d.; 4) Paxil, 60 mg P O q AM; 5) Azmacort, four puffs inhaled q.i.d.; 6) Bactroban topically TP b.i.d.; 7) Diabeta, 5 mg P O q AM; 8) Ferrous Sulfate, 300 mg P O t.i.d.; 9) Proventil inhaler, two puffs inhaled q.i.d. for follow-up in outpatient clinic with Dr. Bartles in one (1) week.
|
What medication has the patient take for pain
|
{
"answer_end": [
1355
],
"answer_start": [
1312
],
"text": [
"Percocet one to two P O q 4 hours prn pain;"
]
}
|
Mr. Notari was admitted to the Orthopaedic Hand Service on 1/18/2006 with a history of increased right shoulder pain following a cellulitis of the right hand. An ESR was checked on admission and was slightly elevated at 18. He was afebrile and non-toxic, therefore was not started on antibiotics. Dilaudid was added to his pain regimen for his increased discomfort. On 9/25/2006 a CT guided right shoulder joint fluid aspiration was performed by Radiology. Analysis of this fluid was not consistent with joint infection. He received Lovenox for DVT prophylaxis during his admission. On HD#4 he was awake, alert, appropriate and afebrile with stable vital signs. His pain was well controlled on oral medications. He was discharged to home with a prescription for COLACE (DOCUSATE SODIUM) 100 MG PO BID, NEXIUM (ESOMEPRAZOLE) 40 MG PO BID, DILAUDID (HYDROMORPHONE HCL) 2-6 MG PO Q4H PRN Pain, ATROVENT HFA INHALER (IPRATROPIUM INHALER) 2 PUFF INH QID PRN Shortness of Breath, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO BID, MS CONTIN (MORPHINE CONTROLLED RELEASE) 45 MG PO QAM, MS CONTIN (MORPHINE CONTROLLED RELEASE) 30 MG PO QPM, SIMVASTATIN 80 MG PO DAILY, TERAZOSIN HCL 10 MG PO DAILY, and Number of Doses Required (approximate): 3, with instructions to do pendulum range of motion exercises regularly, not to drive a motor vehicle, drink any alcohol or operate machinery while taking the medication, drink plenty of water and take a stool softener (Colace) to help prevent constipation, not to drive a car until cleared to do so by a doctor, and to resume home medications unless specifically instructed otherwise. He was also advised to call a doctor or go to a local emergency room if he developed any concerning symptoms. His final joint fluid cultures were pending at the time of discharge, he will be contacted at home if these turn positive.
|
has the patient used atrovent hfa inhaler ( ipratropium inhaler ) in the past
|
{
"answer_end": [
973
],
"answer_start": [
891
],
"text": [
"ATROVENT HFA INHALER (IPRATROPIUM INHALER) 2 PUFF INH QID PRN Shortness of Breath,"
]
}
|
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.
|
Was the patient ever prescribed coumadin
|
{
"answer_end": [
918
],
"answer_start": [
891
],
"text": [
"Coumadin 10 mg p.o. q.h.s.,"
]
}
|
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.
|
has there been a prior prednisone
|
{
"answer_end": [
400
],
"answer_start": [
377
],
"text": [
"PREDNISONE 5 MG PO QAM,"
]
}
|
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 was the dosage prescribed of allopurinol
|
{
"answer_end": [
963
],
"answer_start": [
909
],
"text": [
"he is on his home doses of allopurinol and colchicine,"
]
}
|
The patient is a 37 year old woman with dilated cardiomyopathy admitted with positional chest pain associated with viral prodrome. Her past medical history revealed she was diagnosed with dilated cardiomyopathy in 10-89 and discharged on Lasix, digoxin, and an ACE inhibitor. On 20 May, she was admitted to Orecross Medical Center after complaining of positional chest pain, shortness of breath, and fatigue. On 4 October, she underwent right ventriculogram which showed ejection fraction 24% and global hypokinesis. On 28 May, she complained of four days of diarrhea, nausea, vomiting, and malaise, followed by sharp severe chest pain in the mid chest below the left breast radiating to the back, which was relieved by lying on the left and aggravated by leaning forward or lying on the right. Her past medical history was significant for cardiomyopathy, hypertension, gastritis, ex-intravenous drug abuser for 10 years, anemia, and recent crack cocaine use. On admission, her medications included Lasix, Enalapril, and digoxin with no known drug allergies. Her hospital course was consistent with continuation of her pain through the first day of hospitalization despite an aggressive anti-ischemic regimen. It was found that her myocardial band electrophoresis showed no myocardial band fraction detected and it was decided to shift therapy to a more anti-inflammatory regimen to control her pericarditis with Indocin. With the resolution of her chest pain, the T-wave inversions corrected and she was transerred to the floor on Indocin 50 milligrams 3 times a day, aspirin, Bactrim, Enalapril, and Carafate and remained without chest pain for the next 2 days. The patient was discharged to home with medications on discharge including aspirin, Indocin 50 milligrams by mouth 3 times a day, Enalapril 10 milligrams by mouth each day, and Carafate 1 gram by mouth 4 times a day with follow-up with Dr. Dewitt A. Sisler.
|
What medications has this patient tried for the chest pain
|
{
"answer_end": [
1460
],
"answer_start": [
1383
],
"text": [
"control her pericarditis with Indocin. With the resolution of her chest pain,"
]
}
|
Patient SAMU, CURTIS 759-74-53-9 is a 61-year-old female with multiple medical problems including dilated CMP, s/p chemo and XRT for Breast CA, CAD, s/p MI, COPD, and occasional O2 use. On admission, her VS are T97.8, HR73, BP113/71, RR18, and O2Sat 92%. She presents with dry cough associated with SOB x 2 days and increased DOE after 1/2 block, orthopnea and PND, chronic abd pain, increased Alk Phos, increased bloating, and wheezing without increased O2 need at night. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #29937145) with POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, DIGOXIN 0.125 MG PO QD, on order for LEVOTHYROXINE SODIUM PO (ref #13700176) with POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, COLACE (DOCUSATE SODIUM) 100 MG PO BID, FERROUS SULFATE 325 MG PO BID, MOTRIN (IBUPROFEN) 600 MG PO Q8H Starting Today (10/7) with PRN Pain Food/Drug Interaction Instruction Take with food, REGLAN (METOCLOPRAMIDE HCL) 5 MG PO AC, SIMETHICONE 80 MG PO QID, VITAMIN B1 (THIAMINE HCL) 100 MG PO QD, TRAZODONE 50 MG PO HS, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & WARFARIN, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: aware, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, GABAPENTIN 200 MG PO QD, TORSEMIDE 100 MG PO BID, COZAAR (LOSARTAN) 50 MG PO QD, LEVOCARNITINE 1 GM PO QD Starting Today (8/21), CITALOPRAM 20 MG PO QD, ADVAIR DISKUS 250/50 (FLUTICASONE PROPIONATE/...) 1 PUFF INH BID, NEXIUM (ESOMEPRAZOLE) 20 MG PO QD, LANTUS (INSULIN GLARGINE) 60 UNITS SC QHS, NOVOLOG (INSULIN ASPART), LIPITOR (ATORVASTATIN) 10 MG PO QPM, ATORVASTATIN CALCIUM, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and Sliding Scale (subcutaneously) SC AC with Food/Drug Interaction Instructions to Avoid milk and antacid, Take with food, Take consistently with meals or on empty stomach, and If BS is less than 125, then give 0 units subcutaneously. The patient was placed on order for COUMADIN PO (ref #29937145) and Adriamycin induced CMP HTN IDDM Sarcoid for DVT on 0/29 (goal 2-3). She was placed on po levofloxacin for 7 days and symptoms resolved. Her weight was 227lbs 7/6/05 (dry weight ~200), and she was on torsemide 100mg bid at baseline, with po lasix increased to 200bid x 2 doses, and zaroxyln 5mg po BID x 6 doses added. Tests included ALK Phos: 627, ALT: 71, AST: 65, Card Enzymes: neg, WBC: 6.4, UA: 1.011, 1+prot, 5-10WBC, 2+bact, CXR: LLL opacity, seen best on lateral view, EKG: prolonged PR, q in AVL, flat Ts laterally, unchanged from 9/5, RUQ US: sludge, gall bladder wall thickened 8mm, neg sonographic Murphy's sign, 2/4 Echo
|
Has the patient ever been on torsemide.
|
{
"answer_end": [
2372
],
"answer_start": [
2329
],
"text": [
"she was on torsemide 100mg bid at baseline,"
]
}
|
The patient is an 83-year-old female with a history of coronary artery bypass grafting (CABG) in 1993, a left main and diagonal percutaneous transluminal coronary angioplasty (PTCA) with cypher stent, and a bare metal stent in the diagonal for recurrent chest pain. She was admitted for possible myocardial infarction due to anginal pain, however 3 sets of negative cardiac enzymes and no EKG changes ruled this out. She woke up at 5am with substernal epigastric pain, which was unclear if it was angina or esophageal spasm. She took Maalox and 3 nitroglycerin (NTG) with pain that responded to nitro, blood pressure (BP) dropped 140s to 90s but came right back. Admitted medications included ECOTRIN (Aspirin Enteric Coated) 325 mg PO QD, Atenolol 50 mg PO QD, Ferro-Sequels 1 tab PO QD, Lisinopril 30 mg PO QD, Pravachol (Pravastatin) 80 mg PO QHS, Norvasc (Amlodipine) 5 mg PO QD, Imdur ER (Isosorbide Mononitrate (SR)) 120 mg PO QD, Pilocarpine 2% 1 drop OU BID, Bactrim DS (Trimethoprim/Sulfamethoxazole Double Strength) 1 tab PO BID x 12 doses starting today (10/19), Clobetasol Propionate 0.05% Cream TP BID, Allegra (Fexofenadine HCL) 60 mg PO QD, on order for Allegra PO (ref #483093734), Alphagan (Brimonidine Tartrate) 1 drop OU BID, Plavix (Clopidogrel) 75 mg PO QD, Calcium Carbonate 1,500 mg (600 mg elem Ca)/Vit D 200 IU 1 tab PO QD, Zetia (Ezetimibe) 10 mg PO QD, Metformin 250 mg PO BID, Aciphex (Rabeprazole) 20 mg PO QD, and Plavix, BB, ACE, statin, Zetia. Lipid panel was good with total cholesterol 163 and LDL 86 HDL 43. ACE was uptitrated to optimize BP, increased to 30 mg daily with improved BP with SBP in 110s. The patient had a history of anemia and was continued on iron. HCT was stable in low 30s, 32.6 at discharge. The patient was started on Bactrim for 7 days for a urinary tract infection. All other medications were the same. The patient was discharged in stable condition with instructions to monitor BP with uptitration of ACE, take calcium, follow a cardiac and diabetic diet, watch calcium, and take Lovenox and PPI.
|
What medications has the patient been prescribed for vague symptoms
|
{
"answer_end": [
662
],
"answer_start": [
577
],
"text": [
"that responded to nitro, blood pressure (BP) dropped 140s to 90s but came right back."
]
}
|
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.
|
What mean arterial pressures meds has vet tried in past
|
{
"answer_end": [
304
],
"answer_start": [
272
],
"text": [
"were kept above 65 with Levophed"
]
}
|
This is a 72 year old black female with a history of hypertension, angina, adult onset diabetes, and recurrent syncopal events who was treated with Dilantin for less than a year in 1970 and her last episode was in 1989. She was given Nitro Paste and 1 amp of D50 when she experienced a syncopal event on the morning of admission and her fingerstick glucose was checked. Her medications on admission include aspirin one tablet q d, Questran one pack q d, Micronase 5 mg po q d, Betaxolol eye drops bid to each eye, Pilocarpine eye drops tid to each eye, and eye drops bid to each eye. She also receives monthly Vitamin B12 injections and takes nitroglycerin with chest pain. Physical examination revealed pinpoint constriction of her pupils secondary to her glaucoma eyedrops, bibasilar, coarse crackles in the chest, no jugular venous distention, and nonfocal neurologic exam. Laboratory data includes sodium of 143, potassium of 4.3, chloride of 109, bicarbonate of 20, BUN of 21, creatinine of 1.0, glucose of 160, hematocrit of 43.4, white count of 6.45, and normal coagulation factors. Chest X ray showed a calcific aorta, C spine X ray and head CT were negative, and EKG showed no changes from her baseline. The patient was started on Isordil and Lopressor empirically but these were discontinued and her chest pain is relieved with nitroglycerin. She was discharged to home with plans for a repeat 24 hour Holter as an outpatient with diagnoses of syncope, borderline type II diabetes, stable exertional angina, and glaucoma. Discharge medications include aspirin one tablet po q d, Questran one package po q d, Pilocarpine eye drops tid per eye, Betaxolol eye drops bid per eye, eye drops bid per eye, sublingual nitroglycerin prn chest pain, and Naprosyn 375 mg tid prn.
|
Previous micronase
|
{
"answer_end": [
476
],
"answer_start": [
454
],
"text": [
"Micronase 5 mg po q d,"
]
}
|
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.
|
Was the patient on any medication for her diabetes mellitus
|
{
"answer_end": [
1165
],
"answer_start": [
1142
],
"text": [
"Glucotrol 15 mg q. day,"
]
}
|
Mrs. Wetterauer is a 54-year-old female with coronary artery disease status post inferior myocardial infarction in March of 1997, with sick sinus syndrome, status post permanent pacemaker placement, and paroxysmal atrial fibrillation controlled with amiodarone; also with history of diabetes mellitus and hypertension. On 1/11, she experienced severe respiratory distress and was unable to be intubated on the field. She was ultimately intubated at Sirose, and an echocardiogram showed an ejection fraction of 25 to 30 percent with flat CKs. She was diuresed six liters and a right heart catheterization showed a pulmonary artery pressure of 40/15, wedge of 12, and cardiac output of 5.2. Hemodynamics indicated her cardiac output was dependent on her SVR. At the outside hospital, a right upper lobe infiltrate was noted and she was given gentamicin 250 mg times one, and clindamycin 600 mg. She was diagnosed with pneumonia and treated with clindamycin, which caused resolution of her white count. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. Her last admission was on 10/6 for atypical chest pain, and she was placed on Bactrim Double Strength b.i.d. times a total of seven days, as well as Lovenox 60 mg b.i.d., aspirin 325 p.o. q.d., lisinopril 40 mg p.o. b.i.d., digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. Home medications include amiodarone 200 mg p.o. q.d., Glyburide 5 mg p.o. q.d., Lopressor 50 mg p.o. b.i.d., Prempro 0.625/2.5 p.o. q.d., lisinopril 40 mg p.o. q.d., Coumadin, nitroglycerin sublingual, Zantac, beclomethasone, and Ventolin. Medications on transfer, Lovenox 60 mg b.i.d., aspirin 325 p.o. q.8, digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. The patient was also placed on Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Glyburide 5 mg p.o. q.d., Lasix 20 mg p.o. q.d., atenolol 150 mg p.o. q.d., diltiazem CD 240 mg p.o. q.d., and resolved with 20 mg of Lasix p.o. q.d. Mrs. Wetterauer was admitted to the Aley Coness-o Meoak Medical Center for paroxysmal atrial fibrillation controlled with amiodarone, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma. For her anxiety, the patient was treated acutely with Ativan and her problem resolved quite well, and she became more comfortable in the hospital. Diabetes Mellitus was managed with Glyburide held initially on admission, covered with insulin sliding scale, and restarted on discharge. Edema was managed with Lasix 20 mg p.o. q.d. and resolved with 20 mg of Lasix p.o. q.d. Urinary Tract Infection was managed with antibiotics. She was discharged with medications including amiodarone 200 mg p.o. q.d., lisinopril 40 mg p.o. b.i.d., Tapazole 10 mg
|
Is there a mention of of beclomethasone usage/prescription in the record
|
{
"answer_end": [
1724
],
"answer_start": [
1709
],
"text": [
"beclomethasone,"
]
}
|
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.
|
Why did the patient need oxycodone
|
{
"answer_end": [
1299
],
"answer_start": [
1263
],
"text": [
"oxycodone 5-10 mg q.4h. p.r.n. pain."
]
}
|
Mr. Zack Nieman is a 62-year-old white man with ischemic cardiomyopathy, status post coronary artery bypass graft in 1985 with left internal mammary artery to left anterior descending, saphenous vein graft to posterior descending artery, saphenous vein graft to obtuse marginal branch, and a repeat coronary artery bypass graft done in 1995 with saphenous vein graft to first diagonal, saphenous vein graft to obtuse marginal, and saphenous vein graft to posterior descending artery. He had multiple episodes of pulmonary congestion and was admitted to Rorea Valley Health for IV diuresis. EKG revealed atrial flutter with variable block (2:1 versus 3:1), rate around 120, left bundle branche block, and echocardiogram revealed ejection fraction about 25% with 2+ mitral regurgitation. On admission, his temperature was 97.1, pulse 103, blood pressure 148/94, respirations 18, and O2 saturation 97% on two liters. Because of his rapid ventricular response, Digoxin was started with a loading dose of 0.5 mg, then 0.25 mg times two q. six hours, and the patient was then on a maintenance dose of Digoxin at 0.125 mg p.o. q. day, and his Digoxin level has been maintained around 0.9. For his rate control, the amiodarone was also increased to 400 mg q. day, and the patient was started on anticoagulation with heparin. The patient underwent cardioversion through his AICD by the Electrophysiological Service with successful conversion to normal sinus rhythm, and was loaded with Coumadin and meanwhile on heparin until INR between 2-3. The patient developed hyperthyroidism secondary to amiodarone, treated with PTU, then developed hypothyroidism, treated with Levothyroxine. He was discharged on Amiodarone 400 mg p.o. q.d., Captopril 25 mg p.o. t.i.d., clonazepam 1 mg p.o., Lasix 80 mg p.o. b.i.d., glipizide 5 mg p.o. q.d., levothyroxine sodium 100 mcg p.o. q.d., magnesium oxide 420 mg p.o. q.d., Lopressor 25 mg p.o. b.i.d., nitroglycerin 1/150 (0.4 mg) one tab sublingual q. five minutes times three, Coumadin 5 mg p.o. q. day until INR between 2-3 then the dose needs to be adjusted accordingly to maintain INR between 2-3, Simvastatin 20 mg p.o. q. h.s., Klonopin 0.5 mg p.o. q. a.m., Digoxin 0.125 mg p.o. q.d., isosorbide, mononitrate-SR 30 mg p.o. q.d., and troglipazone 400 mg p.o. q. day.
|
Has the patient had amiodarone. in the past
|
{
"answer_end": [
1255
],
"answer_start": [
1204
],
"text": [
"the amiodarone was also increased to 400 mg q. day,"
]
}
|
The patient, TABIOS, MARLIN, was admitted to the hospital with a diagnosis of congestive heart failure. Upon discharge, the patient was prescribed Atenolol 100 MG PO QD, Lasix (Furosemide) 40 MG PO QD, Reglan (Metoclopramide HCl) 10 MG PO TID, Coumadin (Warfarin Sodium) 3.75 MG PO QPM, Simvastatin 20 MG PO QHS, Insulin 70/30 (Human) 10 UNITS QAM; 0 UNITS QPM SC, Cozaar (Losartan) 100 MG PO QD, and Protonex (Pantoprazole) 40 MG PO QD, with a potentially serious interaction of Simvastatin and Warfarin. The patient was also instructed to follow a fluid restriction of two liters, a diet low in cholesterol and saturated fat, and a two gram Sodium diet. In addition, the patient was informed to take the Reglan with warm water, separately from other pills before meals and to avoid grapefruit unless instructed otherwise. The patient's insulin regiment was modified and the Beta Blocker was changed to once a day Atenolol, and she was instructed to switch to 10 units of 70/30 insulin the morning. The patient was put on a Full Code status and was discharged with instructions to walk as tolerated and to follow up with Asselmeier in 1-2 weeks and to arrange for INR to be drawn on 8/16/04 with follow up INR's to be drawn every 7 days. The patient was also advised to be aware of the potentially serious interaction between Simvastatin and Warfarin, discontinue Metoprolol and Lisinopril, start Cozaar and Atenolol, increase Reglan dose, and VNA for diabetes management, CHF management, and medical compliance.
|
Is there history of use of atenolol
|
{
"answer_end": [
169
],
"answer_start": [
120
],
"text": [
"the patient was prescribed Atenolol 100 MG PO QD,"
]
}
|
Patient Mariano Librizzi was admitted on 4/21/2005 with a viral infection and severe pulmonary hypertension, and discharged on 9/22/2005 to go home. The discharge medications included ECASA (Aspirin Enteric Coated) 81 MG PO QD, with a potentially serious interaction with Warfarin & Aspirin, COLACE (Docusate Sodium) 100 MG PO BID, LASIX (Furosemide) 160 MG PO BID, GLIPIZIDE 10 MG PO BID, OCEAN SPRAY (Sodium Chloride 0.65%) 2 SPRAY NA QID, COUMADIN (Warfarin Sodium) 5 MG PO QPM, JERICH, JOSPEH, M.D. on order for ECASA PO (ref #91585860), ZOLOFT (Sertraline) 150 MG PO QD, AMBIEN (Zolpidem Tartrate) 10 MG PO QHS, KCL SLOW RELEASE 20 MEQ PO BID, ATROVENT NASAL 0.06% (Ipratropium Nasal 0.06%) 2 SPRAY NA TID, NEXIUM (Esomeprazole) 20 MG PO QD, TRACLEER (Bosentan) 125 MG PO BID, VENTAVIS 1 neb NEB Q3H Instructions: during wake hours, ALBUTEROL INHALER 2 PUFF INH Q4H PRN Shortness of Breath, Wheezing, home O2 (8L NC). The patient was also prescribed K-Dur 20 BID, Nexium 20, Lasix 160 BID, Tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft 100, MVI, Oceanspray 2 Spray NA QID, Ambien 10 QHS, Ventavis nebs Q3H, Albuterol Inhaler 2 puff INH Q4H, KCl Slow Release 20 MEQ PO BID, Colace 100 MG PO BID, Atrovent Nasal 0.06%. The diet was House/Low chol/low sat. fat and 4 gram Sodium and they were advised to do walking as tolerated, with serial enzymes/EKG to be continued and Lasix, KCl, ASA 81 also advised. The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien, and to avoid high Vitamin-K containing foods and to give on an empty stomach (give 1hr before or 2hr after food). The patient was followed by the AH service with ACEi, cephalopsporins, GERD nexium prophylaxis and Coumadin for pulmonary microclots on Bx in tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft. The discharge condition was satisfactory.
|
has the patient used acei in the past
|
{
"answer_end": [
1714
],
"answer_start": [
1661
],
"text": [
"The patient was followed by the AH service with ACEi,"
]
}
|
Mr. Faiella is a 78 year old man who presented with two episodes of chest pain and had recently undergone a MV and TV repair with SVG to OM1. An EKG showed pacing and a CK revealed a TnI elevated at 0.17, while Adenosine MIBI revealed a fixed inf/lat defect, consistent with LCX disease. He was sent home with Nitroglycerin, and the pain recurred while watching TV, resolving with one Nitroglycerin tablet. CV: Ischemia was ruled out for MI, added Isordil to regimen, ASA, and continue Carvedilol, Captopril. Likely to have CAD, Adenosine MIBI origin, will stop nitrates. Pt was able to amubulate w/o SOB or CP, CHF: euvolemic, continue Lasix, Aldactone, Digoxin. Neuro: recent history of TIA, on Coumadin, may not want to reverse. On order, he was prescribed ECASA (Aspirin Enteric Coated) 325 mg PO QD, Coumadin PO (ref # 44750239), Captopril 12.5 mg PO TID, Aldactone PO (ref # 94240639), Digoxin 0.125 mg PO QOD, Lasix (Furosemide) 80 mg PO BID, Niferex-150 150 mg PO BID, Nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain HOLD IF: SBP < 100, Aldactone (Spironolactone) 25 mg PO QD, Coumadin (Warfarin Sodium) 6 mg PO QD, Carvedilol 3.125 mg PO BID HOLD IF: SBP < 100, and Celexa (Citalopram) 20 mg PO QD, with potential serious interactions between Aspirin & Warfarin, Captopril & Spironolactone, and Potassium Chloride & Digoxin. He was instructed to call his cardiologist and return to the emergency department if his chest pain recurs, worsens, or he becomes short of breath, and to make an appointment with Dr. Moxness within the next 1-2 weeks. VNA was asked to oversee medications, check vitals, and draw PT/INR once a week, while PT was asked to help Mr. Muskett regain strength, flexibility, and range of motion. Number of Doses Required (approximate): 5. There were overrides on orders for COUMADIN PO (ref # 44750239) and ALDACTONE PO (ref # 94240639) due to Potentially Serious Interactions: ASPIRIN & WARFARIN, CAPTOPRIL & SPIRONOLACTONE, and POTASSIUM CHLORIDE & SPIRONOLACTONE.
|
What medications has patient been on for chest pain in the past
|
{
"answer_end": [
1059
],
"answer_start": [
977
],
"text": [
"Nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain HOLD IF: SBP < 100,"
]
}
|
Patient Mariano Librizzi was admitted on 4/21/2005 with a viral infection and severe pulmonary hypertension, and discharged on 9/22/2005 to go home. The discharge medications included ECASA (Aspirin Enteric Coated) 81 MG PO QD, with a potentially serious interaction with Warfarin & Aspirin, COLACE (Docusate Sodium) 100 MG PO BID, LASIX (Furosemide) 160 MG PO BID, GLIPIZIDE 10 MG PO BID, OCEAN SPRAY (Sodium Chloride 0.65%) 2 SPRAY NA QID, COUMADIN (Warfarin Sodium) 5 MG PO QPM, JERICH, JOSPEH, M.D. on order for ECASA PO (ref #91585860), ZOLOFT (Sertraline) 150 MG PO QD, AMBIEN (Zolpidem Tartrate) 10 MG PO QHS, KCL SLOW RELEASE 20 MEQ PO BID, ATROVENT NASAL 0.06% (Ipratropium Nasal 0.06%) 2 SPRAY NA TID, NEXIUM (Esomeprazole) 20 MG PO QD, TRACLEER (Bosentan) 125 MG PO BID, VENTAVIS 1 neb NEB Q3H Instructions: during wake hours, ALBUTEROL INHALER 2 PUFF INH Q4H PRN Shortness of Breath, Wheezing, home O2 (8L NC). The patient was also prescribed K-Dur 20 BID, Nexium 20, Lasix 160 BID, Tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft 100, MVI, Oceanspray 2 Spray NA QID, Ambien 10 QHS, Ventavis nebs Q3H, Albuterol Inhaler 2 puff INH Q4H, KCl Slow Release 20 MEQ PO BID, Colace 100 MG PO BID, Atrovent Nasal 0.06%. The diet was House/Low chol/low sat. fat and 4 gram Sodium and they were advised to do walking as tolerated, with serial enzymes/EKG to be continued and Lasix, KCl, ASA 81 also advised. The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien, and to avoid high Vitamin-K containing foods and to give on an empty stomach (give 1hr before or 2hr after food). The patient was followed by the AH service with ACEi, cephalopsporins, GERD nexium prophylaxis and Coumadin for pulmonary microclots on Bx in tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft. The discharge condition was satisfactory.
|
Has this patient ever tried o2
|
{
"answer_end": [
968
],
"answer_start": [
906
],
"text": [
"home O2 (8L NC). The patient was also prescribed K-Dur 20 BID,"
]
}
|
The patient was admitted for right leg pain and poor ambulation. She had a history of OA and chronic right sided hip/knee pain with ambulation. On examination, she had pain with ambulation to her right leg, hip, and achy not sharp. X-rays of the right lower extremity joints showed no abnormality, and physical therapy recommended use of a cane. To treat her pain she was given TYLENOL 650mg PO Q6HR ATC and PRN IBUPROFEN. She was maintained on her outpatient cardiovascular medications, including Lisinopril 20 mg PO qd, Hydrochlorothiazide 25 mg PO qd starting today (2/4), Lipitor (Atorvastatin) 10 mg PO qd, Multivitamin Therapeutic (Therapeutic Multivi... ) 1 TAB PO QD, Calcium Carbonate (500 mg elemental Ca++) 500 mg PO TID, and Niacin/Vitamin B3 & Atorvastatin Calcium with an override for awareness of a potentially serious interaction. Blood pressure should be followed up as an outpatient and BP meds titrated as needed. She was cleared to go home with instructions to take TYLENOL at least twice daily to help improve her leg pain, seek medical attention if the leg becomes more red, swollen, or tender, or if there are any fevers or new problems with the leg, and use the cane to assist with walking. She was discharged in stable condition to her son, with instructions to follow up with Lenard Dimmitt for blood pressure, take Tylenol for pain, take Ibuprofen as needed, and call the nurse practitioner within 2 weeks for an appointment.
|
Is there history of use of cardiovascular medications
|
{
"answer_end": [
487
],
"answer_start": [
423
],
"text": [
"She was maintained on her outpatient cardiovascular medications,"
]
}
|
Harrison Fullwood was admitted on 4/3/2005 for ICD placement for HCM. On 7/13/05, Medtronic Dual Chamber DDI/ICD was placed under general anesthesia with a CODE STATUS of Full Code and disposition of Home. ECHO 5/13 showed septal thickness 16mm, posterior wall thickness 19mm with preserved EF 65% and LV outflow tract peak gradient 125mmHg. Holter monitoring 0/2 without any arrhythmias. On admission PE, VS 96.4 74 140/90 20 93% RA. Labs/Studies included CBC, BMP, Coags wnl, EKG NSR. TW flat V5/V6 (old), CXR (portable): cardiomegaly, no e/o ptx, PA/lat CXR AM after no ptx, leads in place, no overt failure. The patient was prescribed Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid, Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily (inc to 40 or 60 during period), Kcl 20meq daily, Verapamil 120mg daily, Patanol 1-2 OU bid prn, Loratidine 10mg daily, Zocor 20mg qhs, Effexor 75mg daily, Metformin 1250mg bid, Mgoxide 500mg daily, Ambien prn, Amox prior to procedures. On order for Motrin PO (ref# 234611479), the patient had a POSSIBLE allergy to Aspirin; reaction is Unknown. The patient was instructed to take Keflex for a 3 day total course, take all medications with food, and avoid grapefruit unless MD instructs otherwise. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. ENDO: ISS. restarted Metformin on morning of d/c. NEURO: cont Effexor. On discharge, the patient was prescribed Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Wheezing, Lasix (Furosemide) 20 mg PO QD Starting Today (10/19) with instructions to titrate his dose 20mg/40mg/60mg as he normally does depending on his degree of swelling, Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache, Magnesium Oxide 560 mg PO QD, Verapamil Sustained Release 120 mg PO QD Starting Today (10/19) with instructions to confirm home dose and resume home dose, Keflex (Cephalexin) 250 mg PO QID X 10 doses, Zocor (Simvastatin) 20 mg PO QHS, Ambien (Zolpidem Tartrate) 10 mg PO QHS PRN Insomnia, Loratadine 10 mg PO QD, Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid, Metformin 1,250 mg PO BID Starting IN AM (10/19), Rhinocort Aqua (Budesonide Nasal Inhaler) 2 Spray Inh BID, Singulair (Montelukast) 10 mg PO QD, Effexor XR (Venlafaxine Extended Release) 75 mg PO QD Number of Doses Required (approximate): 5, Advair Diskus 250/50 (Fluticasone Propionate/...) 1 Puff Inh BID, Nexium (Esomeprazole) 40 mg PO QD, Oxycodone 10 mg PO Q4H PRN Pain, and Atrovent HFA Inhaler (Ipratropium Inhaler) 2 Puff Inh QID. November of 2004, HF symptoms were controlled on Lasix and at baseline he could work. The patient was also advised to take all medications with food and to avoid grapefruit unless MD instructs otherwise, and to take Keflex for a 3 day total course and to take all other medications as the same. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A.
|
Was the patient ever given medication for hf symptoms
|
{
"answer_end": [
2793
],
"answer_start": [
2708
],
"text": [
"November of 2004, HF symptoms were controlled on Lasix and at baseline he could work."
]
}
|
This 53 year old Afro-American female was admitted to the Emergency Room in 1987 with acute atypical chest pain and was later diagnosed with dilated cardiomyopathy, hypertension, and asthma. Upon admission, her blood pressure ranged between 170 to 180/100 to 110, and she was prescribed Beclovent 4 puffs b.i.d., Enalapril 4 mg q.d., Diltiazem 360 mg q.d., and Lasix 40 mg b.i.d. Her physical examination revealed a temperature of 97.6, heart rate of 75 and respiratory rate of 12 after Hydralazine. Labs upon admission showed an SMA-7 of 143, 4.1, 102, 28, 20, 1.2, and 93, CBC of 6.3, 46.1, and 280, PT and PTT of 12.5 and 28.4, ALT of 14, AST of 19, LDH of 197, alkaline phosphatase of 77, total bilirubin of .3, total protein of 7.9, albumin of 4.2, globulins of 3.7, calcium of 9.4, phosphate of 4.4, cholesterol of 210, and triglyceride of 67. She underwent cardiac catheterization on hospital day number one, which demonstrated no coronary artery disease, and was started on Diltiazem 180 mg q.d., Lasix 80 mg b.i.d., and Hydralazine 10 mg t.i.d. After Hydralazine, the heart rate was 75 and the respiratory rate was 12. The patient underwent a Captopril Renogram Test which was negative for renal artery stenosis and other hypertension workup Epinephrine, Dopamine, Metanephrine, VMA and ANA are still pending. The patient's blood pressure was well-controlled throughout her hospital visit in the 130/70's and she was discharged on hospital day number five with medications including Diltiazem 180 mg po q.d., Enalapril 10 mg po q.d., Lasix 80 mg b.i.d., and Hydralazine 10 mg t.i.d., as well as one aspirin per day.
|
Previous hydralazine
|
{
"answer_end": [
499
],
"answer_start": [
437
],
"text": [
"heart rate of 75 and respiratory rate of 12 after Hydralazine."
]
}
|
This is a 48-year-old female who was admitted to the hospital with pneumonia and Klonopin overdose two days prior to admission, having recently completed an antibiotic course at Dale Skin Sonmu Medical Center for pneumonia. She has not taken her lisinopril or methadone in the past. Upon admission, her respiratory rate was 18, O2 saturation 95% on 8 liters of oxygen and she was aggressively given fluids and was started on Levophed for blood pressure support. Her EKG was notable for low voltage on the precordial leads and her saturations were in the high 80's. She was given vancomycin, Levaquin and gentamicin and 3 liters of normal saline. She had a mild troponin elevation on admission, likely secondary to RV strain, and was given a heparin drip with a goal of 60 to 80. Her second PECT showed a small PE to the right upper lobe, but it was not large enough to explain her dramatic presentation. She had severe hypotension and was on two pressors, which were weaned off of on 4/15/06, but had an episode of hypotension when her BiPAP was started. She was given a little bit of low dose dobutamine and then weaned off of that on 3/6/06. She had an elevated eosinophilia on presentation and it was 4% on admission and increased to 8% on 4/21/06. She was empirically covered on admission with vancomycin, levofloxacin and gentamicin. Her antibiotics were given again on 10/16/06 and on 11/13/06. She did complain of bladder spasms while having the Foley in place and was started on Ditropan. She had multiple negative urinalysis and urine cultures. Once the Foley was discontinued, she was able to void and she stopped having bladder spasms. She was started on Monistat for a yeast infection. She did have a history of severe hypertension and her blood pressures were stable, but not high enough to withstand on additional blood pressure lowering medication. It was discussed with her PCP that she perhaps will need this medication restarted as an outpatient. She also had a normal increase in her cortisol level with ACTH stimulation. Her Coumadin was initially given 10, then a dose of 5 and then 2 dose of 7.5. We are continuing her methadone, which has been switched from 20 mg p.o. daily to 10 mg p.o. b.i.d. She was also given a little bit of Ativan while in-house to help with her agitation and anxiety and was initially given a little bit of Haldol, but that was discontinued on 8/4/06 and there was no additional need for that. She was on unfractionated heparin for her presumed PE until 6/15/06 and then changed to Lovenox in the morning and her methadone has been switched from 20 mg p.o. daily to 10 mg p.o. b.i.d. She was given a little bit of low dose lisinopril while in-house. Her blood pressures were stable, but her weight at that time was 157 kg.
|
What is the reason this patient is on ativan
|
{
"answer_end": [
2362
],
"answer_start": [
2293
],
"text": [
"agitation and anxiety and was initially given a little bit of Haldol,"
]
}
|
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.
|
Has the patient had multiple prednisone prescriptions
|
{
"answer_end": [
400
],
"answer_start": [
377
],
"text": [
"PREDNISONE 5 MG PO QAM,"
]
}
|
The patient is a 50 year old man with unstable angina who was referred to the Rhalca Medical Center for cardiac catheterization and coronary artery bypass grafting. He had a four-year history of coronary artery disease and described episodes of chest pain occurring approximately q. two months as well as evidence of shortness of breath due to chronic obstructive pulmonary disease. On admission, he was taking NTG on a twice daily basis for exertional angina and was given intravenous NTG, heparin, and Diltiazem by an EMT. His cardiac risk factors included an 80-pack year smoking history, family history of heart disease, hypercholesterolemia, and non-insulin-dependent diabetes mellitus. His past medical history was notable for interstitial lung disease, hyperlipidemia, GERD, chronic bronchitis, and obstructive sleep apnea. Medications on admission included Cardizem 120mg p.o.b.i.d., Mevacor 20mg p.o.b.i.d., Pepcid 40mg p.o.q.d., Ventolin and Seldane taken on a prn basis. Allergies were NKDA. An ETT Thallium demonstrated reperfusion abnormalities in the inferior and anterior walls. He underwent cardiac catheterization demonstrating 80% distal stenosis of the left main as well as the origin of the LAD with additional occlusion of the midportion of the LAD and distal carotid, 80% stenosis of midportion of left circumflex and proximal occlusion of the right coronary. On the 26th of May, he received double coronary artery bypass graft including pedicle LIMA bypass to the LAD and LAD patch angioplasty with a single aortocoronary saphenous vein bypass graft to the obtuse marginal. He had a low-grade fever and leukocytosis up to 20,000 for which he was started on an empiric course of cefuroxime and clindamycin 300mg p.o.q.i.d. He was evaluated by the Dental Service and prescribed a course of penicillin for a possible periodontal abscess of tooth #32. He was encouraged to see his cardiologist for follow-up and return to Dr. Donnie Daidone office for completion of his antibiotics. Discharge medications included Aspirin 325mg q.d., Diltiazem 120mg p.o.t.i.d., Colace 100mg t.i.d., iron sulfate 300mg t.i.d., Lasix 80mg p.o.b.i.d., Mevacor 20mg p.o.b.i.d., MVI one p.o.q.d., Percocet one to two tabs. q. 4 prn, KCl 40mil/eq p.o.b.i.d., and ciprofloxacin 500mg p.o.b.i.d. X 10 days taken with clindamycin 300mg p.o.q.i.d.
|
has the patient had antibiotics.
|
{
"answer_end": [
2001
],
"answer_start": [
1941
],
"text": [
"Dr. Donnie Daidone office for completion of his antibiotics."
]
}
|
The patient, a 77 year old woman, was admitted with complaint of urinary frequency and AMS. She has a possible allergy to Penicillins with a reaction of RASH and cannot tolerate floroquinolones. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, LISINOPRIL 10 MG PO QD Starting Today ( 6/25 ), KCL SLOW RELEASE PO ( ref # 761602437 ), TOPROL XL ( METOPROLOL SUCCINATE EXTENDED RELEASE ) 100 MG PO BID HOLD IF: hr<55 , sbp<95, LANTUS ( INSULIN GLARGINE ) 19 UNITS QAM SC QAM Starting Today ( 6/17 ), WARFARIN SODIUM 5 MG PO QPM Starting ROUTINE , 20:00 ( Standard Admin Time ), ROSIGLITAZONE 2 MG PO QD, FUROSEMIDE 20 MG PO BID Starting Today ( 6/25 ) PRN Other:LE edema, SIMVASTATIN 10 MG PO QHS, CEFPODOXIME PROXETIL 200 MG PO BID X 16 doses Starting Today ( 6/25 ) HOLD IF: rash, and DIGOXIN 0.125 MG PO QOD with Food/Drug Interaction Instruction to Give with meals. Her AFIB became tachy to 140's with an elevated troponin to 1.69 which rose to a max of 2.41 with no EKG changes and was rate controlled and started on Levofloxacin. She was given 2 doses of vancomycin to cover potential staph infection and had an adenosine MIBI that showed no perfusion defects. Her INR was increasing due to the levofloxacin effect and was switched to ceftriaxone consistant with blood culture succeptabilities. Follow up blood cultures on 0/27 demostrated gram positive cocci in clusters and antibiotics were d/c'd after repeat cultures were negative. Her cardiac workup included an echocardiogram with RV dialation and wall akinesis with apical sparing , a new finding since last echo in '03. We have altered cardiac medications for better rate control by cancelling the coreg( carvedelol ) and Norvasc( amilodipine ) and replacing them with a blood pressure medication, Toprol XL( Metoprolol XL ) to better control the rate of her atrial fibrillation and the digoxin was also added for heart rate control. The patient was discharged in good condition and was given instructions to take the full course of antibiotics which cover the next 8days, to take medications with meals or on empty stomach and to avoid high Vitamin-K containing foods, to call PCP with any changes in urinary symptoms, or fever >101.0, return to ER if any changes in mental status, chest pain, SOB, or syncope, and follow-up with PCP within the next week with INR and digoxin levels. Do not use lasix unless necessary and contact PCP if using more than 1-2 times per week due to possible toxicity with digoxin use.
|
Has the patient ever had lantus ( insulin glargine )
|
{
"answer_end": [
506
],
"answer_start": [
434
],
"text": [
"LANTUS ( INSULIN GLARGINE ) 19 UNITS QAM SC QAM Starting Today ( 6/17 ),"
]
}
|
This is a 66-year-old man with diabetes, hypertension, obesity and non-Hodgkin's lymphoma of the right hip on chemotherapy (R-CHOP) which began on 4/10/06 and will continue for 18 weeks, reporting no complications from ischemic chemotherapy. The patient presented to the emergency room with syncope and was hypotensive on arrival, receiving IV normal saline as volume resuscitation. The second set of cardiac enzymes was positive with a troponin of 2, and an echocardiogram the morning following admission showed a dilated right ventricle consistent with right ventricular strain. A PE protocol CT scan showed a large saddle embolus, and the patient was treated initially with IV heparin, transitioned to Coumadin and then the decision was made to try Lovenox therapy for long-term anticoagulation. Cardiac enzymes normalized and repeat echocardiogram showed mild improvement in right heart function. On admission, the patient's medications were Atenolol 50 daily, lisinopril 5 daily, Protonix 40 daily, metformin 1500 daily, Lantus 60 daily, Humalog 20 before meals, Byetta 5 mcg twice daily, levothyroxine (dose unknown), OxyContin 40 every eight hours, Percocet two tabs every 3 hours as needed for pain and gabapentin (dose unknown).
|
Has the patient had multiple r-chop prescriptions
|
{
"answer_end": [
154
],
"answer_start": [
97
],
"text": [
"right hip on chemotherapy (R-CHOP) which began on 4/10/06"
]
}
|
Mr. Neilsen is a 59-year-old morbidly obese man with a history of morbid obesity, paroxysmal atrial fibrillation, ejection fraction of 40 percent, obstructive sleep apnea on continuous positive airway pressure, history of cellulitis, and presenting with progressive lower extremity weakness bilaterally and urinary incontinence. On admission, EMG showed decreased recruitment in the tibialis anterior and gastrocnemius bilaterally, and he was treated with seven days of Bactrim for resolution of his incontinence and he was not anticoagulated at the moment though Coumadin should be a consideration given his risk of stroke. Two weeks prior to admission he noted some lumbar and sacral pain, nonradiating, worse while moving his right leg, and increasing urinary frequency without burning or urinary incontinence. On the night of admission, while getting up from a chair, his right leg gave out and he fell to the floor without injury or head trauma. His laboratory data on admission showed sodium 140, potassium 4.5, chloride 102, bicarbonate 26, BUN 20, creatinine 0.9, glucose 101, white blood cell count of 9 with 76 polys, 4 bands, hematocrit 37.6 and platelet count of 236, and urinalysis showed 3+ blood and positive leukocyte esterase with 15-20 white blood cells, one plus bacteria and one plus squamous cells. He was started on a trial of Lasix p.o. q day to decrease his peripheral edema to help him with rehabilitation, and he was instructed to apply Nystatin powder for his pannus rash. His medications on discharge included Aspirin 325 mg p.o. q day, Colace 100 mg p.o. b.i.d., Lasix 40 mg p.o. q a.m., Indomethacin 25 mg p.o. t.i.d. p.r.n. pain, Lisinopril 15 mg p.o. q day, multivitamin one tablet p.o. q day, Bactrim DS one tablet p.o. t.i.d., Tamsulosin 0.4 mg p.o. q day, and Miconazole 2% topical powder b.i.d., and he was discharged to rehabilitation care for leg strengthening in a stable condition.
|
Was the patient ever prescribed multivitamin
|
{
"answer_end": [
1760
],
"answer_start": [
1726
],
"text": [
"Bactrim DS one tablet p.o. t.i.d.,"
]
}
|
The patient had continued to remain stable from an ischemia standpoint and a beta-blocker was added back to his regimen and was titrated to a dose of Lopressor 12.5 mg p.o. t.i.d. He continues on aspirin and statin, and he also continues on Isordil 20 mg p.o. t.i.d. and hydralazine 50 mg p.o. t.i.d. for after load reduction, as well as digoxin at 0.125 mg p.o. q.o.d. The patient was aggressively diuresed with intravenous Lasix and Zaroxolyn followed by conversion to oral diuresis with torsemide at the dose of 100 mg p.o. q.d. He was also found to have atrial clot on transesophageal echocardiogram and thus was started on a heparin drip and transitioned on Coumadin, but after a discussion with the CHF Team, the decision was made not to continue Coumadin anticoagulation and instead he was given aspirin and Plavix at full doses. The patient's medication regimen also includes Colace 100 mg p.o. b.i.d., Folate 1 mg p.o. q.d., Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough, Simethicone 80 mg p.o. q.i.d. p.r.n. upset stomach, Multivitamin one tab p.o. q.d., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Tessalon 100 mg p.o. t.i.d. p.r.n. cough, Lipitor 80 mg p.o. q.d., Plavix 75 mg p.o. q.d., Lantus 5 units subcu q.p.m., NovoLog 3 units subcu a.c. and NovoLog sliding scale. The patient is on ACE inhibitor and was restarted on a low-dose beta-blocker at 12.5 mg p.o. t.i.d. as well as his insulin regimen can be adjusted as an outpatient and possibly oral diabetes medications restarted. He is to be discharged to the Com Medical Center for further rehabilitation, with follow-up appointments with Dr. Kyle Yandle in the T Las on 2/28/05 at 08:30 a.m., Dr. Clyde Chatampaya of Elmert Hospital Cardiology 9/26/05 and Raymond Banaag of TRISTONTERN MEDICAL CENTER PCP on 10/3/05 at 01:50 p.m. His sister, Alexis Fernendez, is his health care proxy and is providing substantial social support.
|
has there been a prior robitussin a-c
|
{
"answer_end": [
978
],
"answer_start": [
934
],
"text": [
"Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough,"
]
}
|
An 81-year-old woman with Atrial Fibrillation (AF) on Fondaparinux, no Coumadin secondary to prior epistaxis, Non-small Cell Lung Cancer (NSC Lung Ca), and Pernicious Anemia (Pernicious Anemia) presents with three days of constant chest pain, pleuritic, not exertional, and mostly related to arm movement. Treatment included ACEBUTOLOL HCL 400 MG PO DAILY Starting IN AM ( 8/10 ), ALLOPURINOL 100 MG PO DAILY, VITAMIN C (ASCORBIC ACID) 500 MG PO BID, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 500 MG PO BID, CIPROFLOXACIN 250 MG PO Q12H X 4 doses (Administer iron products a minimum of 2 hours before or after a Levofloxacin or Ciprofloxacin dose dose), DIGOXIN 0.125 MG PO DAILY, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LOVENOX (ENOXAPARIN) 120 MG SC BEDTIME, TARCEVA (ERLOTINIB) 100 mg PO DAILY, FOLIC ACID 1 MG PO DAILY, FUROSEMIDE 40 MG PO DAILY Starting IN AM ( 4/9 ), DILAUDID (HYDROMORPHONE HCL) 0.5 MG PO Q4H PRN Pain (on order for DILAUDID PO, ref# 925975305, POTENTIALLY SERIOUS INTERACTION: TRAMADOL HCL & HYDROMORPHONE HCL, Reason for override: aware), LIDODERM 5% PATCH (LIDOCAINE 5% PATCH) 1 EA TP DAILY, PRAVACHOL (PRAVASTATIN) 20 MG PO BEDTIME, VITAMIN B6 (PYRIDOXINE HCL) 50 MG PO DAILY, ULTRAM (TRAMADOL) 50 MG PO Q6H PRN Pain (on order for ULTRAM PO, ref# 417339527, POTENTIALLY SERIOUS INTERACTION: MORPHINE & TRAMADOL HCL). CT-PE showed no evidence of PE or Deep Venous Thrombosis (DVT) and post Right Lower Lobe Resection changes, with interval resolution of Left Upper Lobe Nodule without new nodules, and possible chronic subsegmental PE. CXR showed no acute process. Factor Xa level was checked to insure Lovenox dosing was therapeutic. Discharge plan included mammogram next week for evaluation, continue pain control with Lidoderm patch, Ultram and low dose Dilaudid as needed for severe pain, continue Tarceva as per outpatient oncologist, continue Lovenox as outpt, continue Lasix at 40mg daily, complete course of Cipro 250mg BID x 3 days, follow up with cardiologist for continued management of heart conditions, and follow up with rehabilitation specialists to try to regain strength and function. Discharge condition was stable.
|
Has the patient ever taken lidoderm for their pain control
|
{
"answer_end": [
1764
],
"answer_start": [
1686
],
"text": [
"mammogram next week for evaluation, continue pain control with Lidoderm patch,"
]
}
|
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
|
What is the patient's current dose does the patient take of her tessalon perels
|
{
"answer_end": [
1209
],
"answer_start": [
1156
],
"text": [
"she was given Tessalon Perels 100mg PO TID PRN cough,"
]
}
|
This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160
|
Has this patient ever tried lasix (furosemide)
|
{
"answer_end": [
1775
],
"answer_start": [
1744
],
"text": [
"LASIX (Furosemide) 20 mg PO QD,"
]
}
|
A 48M with CAD s/p CABG 1997, Type II DM, Hypercholesterolemia, Hypertension and EtOH use was admitted via ED with 2 weeks of dyspnea on exertion and 2 days of severe peripheral oedema. Upon admission, ECASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO BID Starting Today (0/17), Glyburide 10 MG PO BID, Levothyroxine Sodium 75 MCG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5MIN X 2 doses PRN Chest Pain HOLD IF: sbp less than 100 mmHg, Plavix (Clopidogrel) 75 MG PO QD, Lipitor (Atorvastatin) 80 MG PO QHS, Lasix (Furosemide) 80 MG PO QD, Benicar 20 MG PO QD, Glucophage (Metformin) 500 MG PO BID, and Metformin added to his home diabetic regimen upon discharge were prescribed. Allergy to Penicillins was noted. The patient was discouraged from drinking and smoking and was discharged with instructions to measure weight daily, fluid restriction of 2 liters, house/low chol/low sat. fat diet and 2 gram sodium diet, and to walk as tolerated. Follow up appointments with Dr Knickrehm on February, 2005 at Bipa Healthcare Center, Dr Gavilanes at Nysi Medical Center and CHF program on Thurs June with Devin Apana at Sadeland Hospital were scheduled.
|
nitroglycerin 1/150 ( 0.4 mg )
|
{
"answer_end": [
404
],
"answer_start": [
351
],
"text": [
"Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5MIN X 2 doses"
]
}
|
Mr. Laborn is a 54-year-old male with no significant past medical history who presented to his cardiologist with chest pressure while working out. Stress test and cardiac catheterization showed diffuse LAD disease and he was referred to Dr. Pillon for coronary revascularization. His past medical history includes hypertension, diabetes mellitus, hyperlipidemia, COPD, and asthma, and he was not a tobacco user. Preoperative medications included Lisinopril 20 mg p.o. daily, atorvastatin 40 mg p.o. daily, and Xanax dose unknown. Vital signs, physical examination, and preoperative labs were all normal, and on 2/1/05 coronary anatomy showed 95% osteal LAD, 90% proximal LAD, and 70% LAD left dominant circulation. On 0/8/05 he had CABG x2 with a LIMA to the LAD, SVG1 to the D1, and was transferred to the cardiac intensive care unit under stable condition. His course was uncomplicated in the cardiac intensive care unit and all epicardial pacing wires and chest tubes were removed without complication. He was discharged home on postoperative day #4 in stable condition on aspirin 325 mg p.o. q. day, Niferex 150 mg p.o. b.i.d., oxycodone 5 mg p.o. q.6h. p.r.n. pain, Toprol XL 100 mg p.o. q. day, Flovent 44 mcg inhaler b.i.d., and Lipitor 40 mg p.o. daily, and is to follow-up with Dr. Delawyer cardiac surgeon in six weeks and Dr. Eggleston, cardiologist in two weeks.
|
has the patient used niferex in the past
|
{
"answer_end": [
1131
],
"answer_start": [
1073
],
"text": [
"on aspirin 325 mg p.o. q. day, Niferex 150 mg p.o. b.i.d.,"
]
}
|
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.
|
dilaudid
|
{
"answer_end": [
1450
],
"answer_start": [
1408
],
"text": [
"Dilaudid 0.4-0.8 mg p.o. q.4. p.r.n. pain,"
]
}
|
The patient, a 60M with newly-diagnosed DM, hyperlipidemia, glaucoma, h/o EtOH abuse, and erectile dysfunction, presented to the ED for the second time in 3 days with unsteadiness and sleepiness. Workup including head CTA and MRI were negative, and he was discharged with Metformin and plans for Holter and TTE. He returned to the ED with BS 277. No fevers, headaches, focal neuro findings, vertigo, visual changes, CP, SOB, n/v, abd pain, dysuria, or joint pain were found. Labs were significant for glucose 314, elevated lipids (Chol 302, Trig 323, LDL 189), and HbA1c 11.1%. EKG had old j-point elevation laterally, physical and neuro exam were normal. Explanations for episodes considered were TIA of posterior circulation vs. seizure, less likely atypical migraine or sleep disorder. At the time of discharge, the patient was stable and feeling very good. He was given ACETYLSALICYLIC ACID 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 10 MG PO DAILY, GLYBURIDE 2.5 MG PO DAILY X 60 doses, METFORMIN 500 MG PO BID, a low-fat house diet, and acyclovir this week but stopped Wed for possible neuro side effects. Aspirin dose was increased from 81 mg to 325 mg qd and a prescription for an automatic BP cuff for monitoring at home was given. To better manage blood sugars, glyburide was added which should be taken once a day in addition to metformin twice a day, and he should check his blood sugars 3-4 times per day. He will followup with Dr. Clesen on Monday, and will be evaluated this week with TTE with bubble-study to r/o intracardiac source or PFO and EEG if Neurology deems possibility of seizure.
|
What is her current dose of aspirin
|
{
"answer_end": [
1158
],
"answer_start": [
1108
],
"text": [
"Aspirin dose was increased from 81 mg to 325 mg qd"
]
}
|
This 63 year-old male with a history of peripheral vascular disease, hypertension, non-insulin dependent diabetes mellitus, coronary artery disease, aortic stenosis, and status post bilateral lower extremity bypass grafts presented to the hospital with increasing left lower extremity pain. At which time tPA infusion was commenced and an occlusion of the left lower extremity vein graft was found in the area of the mid-thigh with no passage of contrast and minimal reconstitution of collaterals to his foot. He was managed medically for a few days and underwent catheterization which revealed a right dominant system, a discreet 40% lesion in the proximal left main, a discreet 30% lesion in the proximal left anterior descending artery, 100% lesion in the first marginal branch of the left circumflex artery, as well as 100% lesion in the second marginal branch of the left circumflex artery. He was taken to the operating room on 0/27/02 for an aortic valve replacement with a #23 Carpentier-Edwards pericardial valve and mitral valvuloplasty with an Alfieri suture repair, as well as coronary artery bypass graft times three with left internal mammary artery to the left anterior descending artery, left radial to obtuse marginal one, and left radial to posterior descending artery. During his hospital course he was on MEDICATIONS: Glipizide 5 mg b.i.d., Hydrochlorothiazide 50 mg q.d., Lisinopril 20 mg q.d., Simvastatin 20 mg q.d., Amlodipine 5 mg q.d., Imdur 30 mg q.d., and Toprol 100 mg q.d. and enteric coated aspirin, and he remained on his aspirin and Lopressor, as well as Coumadin. He was placed on the Portland protocol and remained on a full ten-day course of Flagyl and Cefotaxime for his preoperative pneumonia. On his pre-discharge examination he was discharged to rehabilitation with DISCHARGE MEDICATIONS: Coumadin 4 mg p.o. q.hs to maintain INR between 2 and 3, aspirin, Diltiazem 30 mg t.i.d., Simvastatin 20 mg q.d., Colace 100 mg t.i.d., Nexium 20 mg q.d., Niferex-150 b.i.d., Glipizide 5 mg b.i.d., Lasix 40 mg b.i.d., and Lopressor 50 mg b.i.d. with CZI sliding scale.
|
Previous lopressor
|
{
"answer_end": [
1576
],
"answer_start": [
1550
],
"text": [
"his aspirin and Lopressor,"
]
}
|
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 nitrospray
|
{
"answer_end": [
544
],
"answer_start": [
494
],
"text": [
"They gave two nitrospray, blood pressure decreased"
]
}
|
The patient had been taking Ativan of 3-4 mg q.d. for anxiety for the past two months and abruptly stopped taking it on March 1995 after which she started to have feelings of disorientation, and had been taking chloral hydrate 500 to 1000 mg q.h.s. for five days and Compazine with one dose. CURRENT MEDICATIONS: At home, patient took insulin NPH 25 units in the morning with Regular 10 units in the morning, aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose, and chloral hydrate 500 to 1000 mg q.h.s. for five days. On admission, her laboratory examination was significant for BUN of 17, creatinine of 1.0, glucose was 364, liver function tests were within normal limits, white count was 7.2, hematocrit was 36, and platelet count was 266. Neurology consultation was obtained who felt that patient's peripheral neuropathy was probably secondary to longstanding diabetes but felt that some of her symptomatology could be consistent with porphyria. Psychiatry felt that this episode was consistent with generalized anxiety disorder separated by post dysthymia and suggested phenothiazines which are proven to be safe in porphyria for treatment. She was started on Trilafon 2 to 4 mg p.o. p.r.n. q.6h. for anxiety and Keflex 500 mg p.o. t.i.d. for treatment. The patient was also seen to be orthostatic which was felt to be secondary to dehydration secondary to poor p.o. intake prior to admission and was treated with normal saline boluses and her orthostasis improved. Her Lopressor was also held with this episode of orthostasis. The Watson-Schwartz test done by Dr. Mohar on patient very early in the admission was negative which made an acute porphyria attack very unlikely. These episodes were felt to be secondary to a combination of anxiety attack and rapid taper of Ativan which she had been taking at moderately high doses for the last two months. Patient also developed urinary tract infection symptoms and her urine culture showed greater than 100,000 colonies of E. coli which were pansensitive. She was discharged to home on August in good condition on medications Aspirin 81 mg p.o. q.d., insulin NPH 25 units subcutaneously q.a.m., insulin regular 10 units subcutaneously q.a.m., Trilafon 2 mg p.o. q.6h., and Keflex 500 mg p.o. t.i.d. Follow-up will be with Dr. Dario Rodriquz.
|
What medications has the patient ever tried for urinary tract infection symptoms prevention
|
{
"answer_end": [
1318
],
"answer_start": [
1278
],
"text": [
"Keflex 500 mg p.o. t.i.d. for treatment."
]
}
|
A 79-year-old male with history of non-insulin dependent diabetes, coronary artery disease, congestive heart failure, hypertension, chronic renal failure, and left toe amputation on 7/1/06 was admitted for debridement and antibiotics. An MRA on 10/3/06 demonstrated on the right a multifocal high-grade stenosis of the proximal, anterior tibial, the tibioperoneal trunk and the proximal, posterior tibial arteries and included peroneal artery at the midcalf, two-vessel runoff and on the left diffuse high-grade stenoses of the anterior tibial, posterior tibial arteries and occlusion of the peroneal artery in the dorsalis pedis. The patient presented with bleeding from the site of the left toe amputation beginning two weeks ago associated with throbbing pain, soreness, erythema and swelling and exacerbated blood pressure when walking and only treated by narcotics. Neuro and Psych: The patient has delirium postoperatively for which he was placed on soft restraints and received Zyprexa. Cardiac: Upon admission, potassium was noted to be elevated and the patient had EKG changes associated with hyperkalemia and received Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin for coronary artery disease related event prophylaxis. Blood pressure was controlled with isosorbide dinitrate, Norvasc, lisinopril, and Lopressor. Pulmonary: No events. Maintained oxygen saturation greater than 90% on room air. Renal: Creatinine was stable in the mid 3s and trended down to 2.6 at the time of discharge below his baseline of 4-5. Voiding without difficulty at the time of discharge. Maintained on his renal medications. FEN/GI: Tolerated regular diet. Lactulose and Colace to prevent constipation while taking narcotics, also had Dulcolax p.r.n. Zinc and Vitamin C was started per the Nutrition consult. Hematology: He received heparin for DVT prophylaxis. His hematocrit remained stable. He had some oozing from the right thigh but this resolved with a pressure dressing. ID: He was treated throughout his hospitalization with vancomycin, levofloxacin and Flagyl for methicillin-resistant Staphylococcus aureus that grew from the wound after the first and second irrigation and debridement. The levofloxacin and Flagyl were discontinued prior to discharge. He will continue his vancomycin at the time of discharge. Endocrine: Diabetes controlled. He was maintained on his Prandin and insulin sliding scale for glycemic control. He also received Vitamin D, Calcitriol, Nephrocaps, Epogen, and Aranesp. His incision remained clean, dry and intact without erythema or exudate. He was afebrile with stable signs at the time of discharge. ACTIVITY INSTRUCTIONS: He is nonweightbearing on the left lower extremity to protect the open toe. COMPLICATIONS: None. DISCHARGE LABS: Laboratory tests at the time of discharge include sodium 138, potassium 4.1, chloride 111, bicarbonate 21, BUN 35, creatinine 2.6, calcium 9.0, magnesium 1.9, vancomycin 19.5, white blood cell count 7.3, hemoglobin 9.9, hematocrit 30.2, platelets 221. DISCHARGE MEDICATIONS: His medications at discharge include aspirin 325 mg p.o. daily, vitamin C 500 mg p.o. b.i.d., calcitriol 0.5 mcg p.o. daily, Colace 100 mg p.o. daily, heparin 5000 units subcutaneous t.i.d., isosorbide dinitrate 10 mg p.o. t.i.d., lactulose 30 mL p.o. t.i.d., lisinopril 50 mg p.o. daily, Lopressor 50 mg p.o. q.6h., Prandin 0.5 mg p.o. with each meal, Aranesp 40 mcg subcutaneous every week, sliding scale insulin, insulin aspart 4 units, Tylenol p.r.n., Dilaudid 2-4 mg p.o. q.4h. as needed for pain, milk of magnesia as needed for constipation, Reglan for nausea, oxycodone for pain 5-10 mg p.o. q.4h. hours
|
Has this patient ever been prescribed flagyl
|
{
"answer_end": [
2095
],
"answer_start": [
2034
],
"text": [
"vancomycin, levofloxacin and Flagyl for methicillin-resistant"
]
}
|
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week.
|
has the patient had atrovent
|
{
"answer_end": [
2062
],
"answer_start": [
2028
],
"text": [
"Atrovent 2 puffs four times a day,"
]
}
|
Mr. Lewter is a 65-year-old gentleman with a history of non-insulin-dependent diabetes mellitus, hypertension, dyslipidemia, and peripheral vascular disease who presented to Tci Prosamp Memorial Hospital on 5/1/06 with unstable angina. EKG revealed sinus tachycardia with a new incomplete left bundle-branch block and downsloping 1-1.5 mm ST depressions in V3 through V6 and 1 mm depression in aVL. Cardiac catheterization revealed an ostial 100% stenosis in the left circumflex coronary artery, a proximal 60% stenosis and a mid 50% stenosis in the left anterior descending coronary artery, a proximal 80% stenosis and a mid 60% stenosis in the right coronary artery, a right dominant circulation, an ejection fraction of 30%, and collateral flow from the second diagonal to the third marginal in the right posterior left ventricular branch to the second marginal, as well as left ventricular hypokinesis and severe inferior and apical. The patient was not heparinized due to the fact that he was on Coumadin for peripheral vascular disease with a therapeutic INR. On 9/18/06, the patient underwent coronary artery bypass graft x3 with left internal mammary artery to left anterior descending coronary artery, a sequential graft and a vein graft connecting from the aorta to the second obtuse marginal coronary artery and then to the left ventricular branch. He was on medications including Lopressor 37.5 mg b.i.d., aspirin 325 mg daily, Colace 100 mg b.i.d., Pepcid 20 mg IV q.12h., insulin sliding scale, atorvastatin 80 mg daily, glipizide, Avandia, Zestril, metformin, meclizine, lactulose, vitamin C, Protonix, Niaspan, Neurontin, Zincate, and Coumadin for peripheral vascular disease. The patient was started on oral medication of glipizide 5 mg and was covered with a NovoLog sliding scale, was transfused 3 units of packed red blood cells, re-started on Coumadin for his reinsertion, and was started on Flomax 0.4 mg once a day. He had some urinary retention postoperatively and did require Foley catheter placement. He was discharged on Enteric-coated aspirin 81 mg QD, Colace 100 mg b.i.d. while taking Dilaudid, Lasix 40 mg QD x3 doses, glipizide 5 mg daily, Dilaudid 2-4 mg every three hours p.r.n. pain, lisinopril 2.5 mg daily, Niferex 150 mg b.i.d., Toprol-XL 150 mg QD, Lipitor 80 mg daily, Flomax 0.4 mg QD, potassium chloride slow release 10 mEq QD x3 doses with Lasix and Coumadin QD per INR result, and the patient will receive 4 mg of Coumadin this evening for his reinsertion and was instructed to remain on his Flomax until that time. Mr. Jana was discharged to rehab in stable condition and will follow up with his cardiologist Dr. Reuben Duttinger in one week, his heart failure cardiologist Dr. Wilton Durkee on 11/10/06 at 1:30 in the afternoon, and Urology Clinic at the Centsson Medical Center for his urinary retention in one week.
|
has there been a prior glipizide
|
{
"answer_end": [
1574
],
"answer_start": [
1509
],
"text": [
"atorvastatin 80 mg daily, glipizide, Avandia, Zestril, metformin,"
]
}
|
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->
|
has the patient had warfarin
|
{
"answer_end": [
266
],
"answer_start": [
213
],
"text": [
"with a potentially serious interaction with Warfarin,"
]
}
|
Mr. Lahm is a 43 year old male with Down's syndrome who was admitted with multiple episodes of syncope over the prior 8-10 years, characterized by emesis followed by loss of consciousness with a question of seizure like activity. In the Emergency Room he was noted to be somewhat groggy and had a brief episode of apparent loss of consciousness with a question of apnea, and had a heart rate of 30 beats per minute. He was intubated in the CT scan room, sedated and paralyzed while the study was completed. When he arrived in the Intensive Care Unit, he had a heart beat in the 20s with complete heart block, which was transient and with subsequent return to normal sinus rhythm. His neurological exam was nonfocal, electrolytes were normal, his EKG showed sinus tachycardia with an axis of 0, ST flattening in leads V5 and V6, I in L and a question of a Q in III. Chest X-ray raised the question of an infiltrate in the left base. He was ruled out for myocardial infarction, despite an elevated CK and the MB fraction was negative on electrophoresis. On the morning of February, he spiked a temperature to 102.3 and was begun on Penicillin. Later on February he had an episode of complete heart block with asystole for 9 seconds. Otherwise, he alternated sinus tachycardia and second degree heart block with runs of bradycardia at the rate of 30-40 and also tachycardia. A temporary pacemaker was placed on February through the left subclavian approach and he was hemodynamically stable, except for intermittent hypertension, which was treated with Nifedipine. He was switched from Nifedipine to Captopril for treatment of his hypertension and his fever was treated with Cefotetan for presumed aspiration pneumonia, which resulted in a delay in his pacemaker placement. He was transferred to the Cardiology Wa Nas O on March, 1993 to await pacemaker placement. He underwent permanent pacemaker placement in the Operating Room with anesthesia backup in case there was need for intubation because the patient had difficulty remaining still. The medications at discharge were: Kefzol 500mg q.i.d. for 3 days, and Lisinopril 10mg p.o. q day. He will followup with Dr. Antis on January, 1993 and in TYTAZE TH IONO VALLEY HEALTH with Dr. Filiberto Schie. Secondary Diagnoses were pacemaker placement and Down's syndrome.
|
Has this patient ever been treated with kefzol
|
{
"answer_end": [
2106
],
"answer_start": [
2040
],
"text": [
"The medications at discharge were: Kefzol 500mg q.i.d. for 3 days,"
]
}
|
The patient is a 65-year-old female who presented with the sudden onset of right upper quadrant and epigastric abdominal pain. She had been given some Demerol with some relief but she had persistent pain. An ultrasound two years prior to admission showed sludge in her gallbladder with no other abnormalities noted and an ultrasound on the night of admission showed multiple small stones and a gallbladder with sludge and thickening of the gallbladder wall. She was admitted to the Teeleah Valley Medical Center, given Vistaril, Premarin, Clinoril, and triple intravenous antibiotics, kept NPO, and placed on intravenous hydration. On 10 of May, she underwent an esophagogastroduodenoscopy, a cholecystectomy with an intraoperative cholangiogram, and common bile duct exploration with T-Tube placement. Intraoperatively, she was found to have a large inflamed gallbladder with multiple small cholesterol stones in her gallbladder and two stones in her common duct. Post-operatively, she remained stable and was transferred to the Recovery Room and eventually back to the floor. On 0/30/9l, she was started on sips of clear fluids and was up out of bed voiding on her own. By 10/19/9l, she was tolerating a regular diet. On 1/12/9l, she had a normal T-Tube cholangiogram and was clamped and was discharged to home on 1/9/9l to be followed up by Dr. Tendick in Clinic.
|
Previous premarin
|
{
"answer_end": [
548
],
"answer_start": [
519
],
"text": [
"Vistaril, Premarin, Clinoril,"
]
}
|
This is a 72 year old black female with a history of hypertension, angina, adult onset diabetes, and recurrent syncopal events who was treated with Dilantin for less than a year in 1970 and her last episode was in 1989. She was given Nitro Paste and 1 amp of D50 when she experienced a syncopal event on the morning of admission and her fingerstick glucose was checked. Her medications on admission include aspirin one tablet q d, Questran one pack q d, Micronase 5 mg po q d, Betaxolol eye drops bid to each eye, Pilocarpine eye drops tid to each eye, and eye drops bid to each eye. She also receives monthly Vitamin B12 injections and takes nitroglycerin with chest pain. Physical examination revealed pinpoint constriction of her pupils secondary to her glaucoma eyedrops, bibasilar, coarse crackles in the chest, no jugular venous distention, and nonfocal neurologic exam. Laboratory data includes sodium of 143, potassium of 4.3, chloride of 109, bicarbonate of 20, BUN of 21, creatinine of 1.0, glucose of 160, hematocrit of 43.4, white count of 6.45, and normal coagulation factors. Chest X ray showed a calcific aorta, C spine X ray and head CT were negative, and EKG showed no changes from her baseline. The patient was started on Isordil and Lopressor empirically but these were discontinued and her chest pain is relieved with nitroglycerin. She was discharged to home with plans for a repeat 24 hour Holter as an outpatient with diagnoses of syncope, borderline type II diabetes, stable exertional angina, and glaucoma. Discharge medications include aspirin one tablet po q d, Questran one package po q d, Pilocarpine eye drops tid per eye, Betaxolol eye drops bid per eye, eye drops bid per eye, sublingual nitroglycerin prn chest pain, and Naprosyn 375 mg tid prn.
|
Why did the patient need nitroglycerin
|
{
"answer_end": [
673
],
"answer_start": [
633
],
"text": [
"and takes nitroglycerin with chest pain."
]
}
|
This 81-year-old Italian-speaking gentleman was admitted to M Valley Medical Center with rising chest pain. Upon admission, his vital signs were normal and his physical examination was unremarkable. Cardiac catheterization revealed 30% mid RCA occlusion, 40% distal RCA, 90% ostial OM1, 90% mid CX, 80% proximal LAD, 99% mid LAD and 60% mid LM. EKG showed normal sinus rhythm and an incomplete right bundle-branch block. During his hospital stay, he was started on beta-blockers, statins, fluid resuscitation and vasopressor administration, subcu insulin, prednisone, Plavix, and antibiotics. He experienced agitation and delirium, for which he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n. Later during the hospital stay, he became hypotensive, requiring Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. He was also on Lopressor 25 orally every 6 hours, Diltiazem 125 mg orally daily, Furosemide 20 mg orally daily, Methylprednisolone 30 mg IV every 8 hours, Atorvastatin 80 mg orally daily, Allopurinol 100 mg orally daily, Ativan 0.5 mg orally at bedtime, Nexium 20 mg orally daily, and Proscar 5 mg orally every night. Tight glycemic control was maintained with Portland protocol in the immediate postop period and subsequently with subcu insulin. Incidental radiologic finding of a renal mass consistent with renal cell carcinoma was also found. Support for the patient's family was provided throughout the hospital course, and the patient was discharged with Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, Nexium 20 mg everyday, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath.
|
Has the patient had multiple beta-blockers prescriptions
|
{
"answer_end": [
488
],
"answer_start": [
447
],
"text": [
"he was started on beta-blockers, statins,"
]
}
|
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.
|
Previous digoxin
|
{
"answer_end": [
375
],
"answer_start": [
315
],
"text": [
"Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg"
]
}
|
Mrs. Wetterauer is a 54-year-old female with coronary artery disease status post inferior myocardial infarction in March of 1997, with sick sinus syndrome, status post permanent pacemaker placement, and paroxysmal atrial fibrillation controlled with amiodarone; also with history of diabetes mellitus and hypertension. On 1/11, she experienced severe respiratory distress and was unable to be intubated on the field. She was ultimately intubated at Sirose, and an echocardiogram showed an ejection fraction of 25 to 30 percent with flat CKs. She was diuresed six liters and a right heart catheterization showed a pulmonary artery pressure of 40/15, wedge of 12, and cardiac output of 5.2. Hemodynamics indicated her cardiac output was dependent on her SVR. At the outside hospital, a right upper lobe infiltrate was noted and she was given gentamicin 250 mg times one, and clindamycin 600 mg. She was diagnosed with pneumonia and treated with clindamycin, which caused resolution of her white count. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. Her last admission was on 10/6 for atypical chest pain, and she was placed on Bactrim Double Strength b.i.d. times a total of seven days, as well as Lovenox 60 mg b.i.d., aspirin 325 p.o. q.d., lisinopril 40 mg p.o. b.i.d., digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. Home medications include amiodarone 200 mg p.o. q.d., Glyburide 5 mg p.o. q.d., Lopressor 50 mg p.o. b.i.d., Prempro 0.625/2.5 p.o. q.d., lisinopril 40 mg p.o. q.d., Coumadin, nitroglycerin sublingual, Zantac, beclomethasone, and Ventolin. Medications on transfer, Lovenox 60 mg b.i.d., aspirin 325 p.o. q.8, digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. The patient was also placed on Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Glyburide 5 mg p.o. q.d., Lasix 20 mg p.o. q.d., atenolol 150 mg p.o. q.d., diltiazem CD 240 mg p.o. q.d., and resolved with 20 mg of Lasix p.o. q.d. Mrs. Wetterauer was admitted to the Aley Coness-o Meoak Medical Center for paroxysmal atrial fibrillation controlled with amiodarone, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma. For her anxiety, the patient was treated acutely with Ativan and her problem resolved quite well, and she became more comfortable in the hospital. Diabetes Mellitus was managed with Glyburide held initially on admission, covered with insulin sliding scale, and restarted on discharge. Edema was managed with Lasix 20 mg p.o. q.d. and resolved with 20 mg of Lasix p.o. q.d. Urinary Tract Infection was managed with antibiotics. She was discharged with medications including amiodarone 200 mg p.o. q.d., lisinopril 40 mg p.o. b.i.d., Tapazole 10 mg
|
Has this patient ever tried aspirin
|
{
"answer_end": [
1354
],
"answer_start": [
1332
],
"text": [
"aspirin 325 p.o. q.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.
|
Is the patient currently or have they ever taken hydrochlorothiazide
|
{
"answer_end": [
1418
],
"answer_start": [
1386
],
"text": [
"Hydrochlorothiazide 25 mg PO QD,"
]
}
|
Patient Omar J. Coolbaugh, a 71-year-old female post cardiac transplant with allograft coronary artery disease, bilateral carotid disease, TIA, diabetes, and obesity, was admitted on 11/8/2007 and discharged on 4/14/2007 with s/p angioplasty and stenting. The medications on admission included Mycophenolate Mofetil 1000 mg PO BID, Oxybutynin Chloride XL 10 mg PO QD, Insulin Glargine 20 units SC QAM, Furosemide PO QD, Clopidogrel 75 mg PO QD, Pravastatin 40 mg PO QHS, Prednisone 5 mg PO QD, Cyclosporine (Sandimmune) 75 mg PO BID, Metoprolol Succinate Extended Release 50 mg PO QD, and Fenofibrate (Tricor) 48 mg PO QD. Elective cardiac catheterization was performed, revealing double vessel disease and successful PTCA/Stenting of LAD was done using XB3.5 guide, BMW, with no residual stenosis. The patient was advised to take Enteric Coated ASA 325 mg PO Daily, Plavix (Clopidogrel) 75 mg PO Daily, Cyclosporine (Sandimmune) 75 mg PO BID, Tricor (Fenofibrate (Tricor)) 48 mg PO Daily, Lasix (Furosemide) 40 mg PO Daily, Insulin Glargine 20 units SC Daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO Daily, CellCept (Mycophenolate Mofetil) 1,000 mg PO BID, Ditropan XL (Oxybutynin Chloride XL) 10 mg PO Daily, Pravachol (Pravastatin) 40 mg PO Bedtime, Prednisolone Sodium Phosphate 5mg/5ml 5 mg PO Daily, and vitamins, with ASA 325 and Plavix for life and other medications at usual doses, plus TNG 0.4 mg (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 doses PRN Chest Pain. The importance of both aspirin and taking medications consistently was stressed and the patient understands, with diet house/low chol/low sat. fat and activity light activity with no heavy lifting or driving x 2 days, ok to shower, no swimming or bathing x 5 days and lift restrictions of not lifting greater then 10-15 pounds. Follow up appointments were scheduled for Heart Failure Clinic 2-4 weeks and patient was discharged in stable condition and advised to drink plenty of fluids over the next several days, and to call with any questions or concerns.
|
Has this patient ever been on pravastatin
|
{
"answer_end": [
470
],
"answer_start": [
445
],
"text": [
"Pravastatin 40 mg PO QHS,"
]
}
|
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs.
|
Has the patient ever been on magnesium
|
{
"answer_end": [
1496
],
"answer_start": [
1435
],
"text": [
"was kept on potassium and magnesium scales while in hospital."
]
}
|
MAZINGO, THOMAS 281-40-01-4 was admitted for CHF and discharged on 7/14/04. The patient, a 63 year old female with a history of resistant diabetes, morbid obesity, coronary artery disease, and hypertension, presented with one week of shortness of Breath. Examination revealed a respiratory rate of 22, oxygen saturation of 98% on 2L, bibasilar crackles, decreased breath sounds, scattered wheezes, and a normal heart exam. Labs and studies were notable for cardiac enzymes negative x3, BNP marginally elevated at 191, glucose of 286, A1c elevated at 10.3, and TSH of 3.847. An elevated PTT of 64.9 of uncertain significance was also found. The patient was ruled out for ischemia and given low-salt and ADA 1800 diets. She was prescribed Tylenol (Acetaminophen) 650 mg PO Q4H PRN Headache, ECASA (Aspirin Enteric Coated) 325 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 80 mg PO BID starting today, Insulin NPH Human 110 units SC QAM, NTG 1/150 (Nitroglycerin 1/150 (0.4 mg)) 1 Tab SL Q5min x 3 PRN Chest Pain, Verapamil Sustained Release 240 mg PO BID, Flovent (Fluticasone Propionate) 220 mcg Inh BID, Diovan (Valsartan) 160 mg PO QD, Vioxx (Rofecoxib) 12.5 mg PO QD, Duoneb (Albuterol and Ipratropium Nebulizer) QID with Q2H Albuterol O/N, Lipitor (Atorvastatin) 10 mg PO QD, Prilosec (Omeprazole) 20 mg PO QD, Albuterol Nebulizer 2.5 mg Neb Q2H PRN Shortness of Breath, 3/0.5 mg Inh Q6H PRN Shortness of Breath, and Heparin 5000 SC TID for DVT prophylaxis, as well as 80 IV Lasix in the ED and put out 1200 cc. She was instructed to follow-up with Dr. Ross Ogston on Friday 6/8/04, take Lasix pills twice a day until she sees Dr. Nicoll, and call her doctor if she has fever, chills, shortness of breath, or chest pain.
|
Has this patient ever been treated with NTG 1/150 ( nitroglycerin 1/150 ( 0.4 mg ) )
|
{
"answer_end": [
1033
],
"answer_start": [
958
],
"text": [
"NTG 1/150 (Nitroglycerin 1/150 (0.4 mg)) 1 Tab SL Q5min x 3 PRN Chest Pain,"
]
}
|
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week.
|
Has the patient taken medication for pain
|
{
"answer_end": [
2766
],
"answer_start": [
2717
],
"text": [
"Tylenol 325 mg p.o. every four hours p.r.n. pain,"
]
}
|
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.
|
lipitor ( atorvastatin )
|
{
"answer_end": [
673
],
"answer_start": [
638
],
"text": [
"LIPITOR (Atorvastatin) 80 MG PO QD,"
]
}
|
Ms. Christin is an 80-year-old female who presented to an outside hospital with chest pain and shortness of breath. She took one sublingual Nitroglycerin without relief, followed by two more without relief and was then treated with intravenous Lasix, morphine, and Nitroglycerin which resulted in resolution of her pain. Her medical history includes hypertension, hypercholesterolemia, angina, Paget's disease, anemia, and osteoarthritis. An EKG at the hospital showed anterolateral ST depression and her enzymes were negative, ruling out myocardial infarction. Her cardiac symptomatology began in the fall of 1999 and evaluation showed high cholesterol with an LDL 141, EKG with LVH and nonspecific T wave flattening, and a Thallium stress test that was stopped secondary to shortness of breath. Upon admission to Ster Hospital for evaluation of her angina, her laboratory values were consistent with a myocardial infarction and her peak CK was 459 with an MB of 28.7. Her discharge medications include Aspirin 81 mg daily, iron 300 mg three times a day, Hydrochlorothiazide 25 mg daily, Lisinopril 5 mg daily, multivitamin one daily, Relafen 500 mg orally a day, Imdur 60 mg orally a day, Plavix 75 mg daily for 29 days, Lipitor 40 mg daily, Atenolol 25 mg orally a day, and magnesium oxide 420 mg daily. Follow-up with Dr. Porter Luckenbaugh in SH Cardiovascular Group on January at 1:00 p.m. and with Dr. Sammy Kleindienst in the Greenetons Opi Hospital Hematology Clinic.
|
What was the dosage prescribed of hydrochlorothiazide
|
{
"answer_end": [
1088
],
"answer_start": [
1025
],
"text": [
"iron 300 mg three times a day, Hydrochlorothiazide 25 mg daily,"
]
}
|
Patient was admitted to the Toott Hospital surgery service after undergoing LRYGB and was transferred to the floor from the PACU in stable condition. Pain was controlled and no issues were reported overnight into POD1. The patient had an UGI on POD1 that was negative for obstruction or leak, and was started on a Stage I diet which was tolerated well. The following day the patient was started on a Stage II diet that was tolerated as well, but initially struggled to have adequate intake. The patient was started on ALBUTEROL INHALER 2 PUFF INH QID PRN Shortness of Breath, Wheezing, LANTUS (INSULIN GLARGINE) 60 UNITS SC DAILY, ROXICET ORAL SOLUTION (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain, ZANTAC SYRUP (RANITIDINE HCL SYRUP) 150 MG PO BID, ACTIGALL (URSODIOL) 300 MG PO BID, and LEVAQUIN (LEVOFLOXACIN) 500 MG PO DAILY with instructions to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose, and to cycle (hold 1 hr before to 2 hr after) if on tube feeds, and to take 2 hours before or 2 hours after dairy products. Sugars remained high in 200's during admission and patient was seen by Endocrine service and sugars finally improving with lantus 60 sc hs. The patient also had some difficulties with urination on POD4 and required a foley catheter for about a day, but was d/c'd the AM before she was discharged and urinated without incident. Patient was noted to have a UTI at discharge and was started on three day course of levaquin. The patient was discharged in stable condition, tolerating stage II diet well, ambulating, voiding independently, and with adequate pain control. The patient was given explicit instructions to follow-up in clinic with Dr. Truglia in 1-2 weeks and sent home with VNA for wound checks and close sugar control with instructions to f/u with Leland Bredeson by phone and record fingersticks, and to f/u with her PCP if she has further problems with urination. The patient was also instructed to shower but not bathe, swim or otherwise immerse her incision, not to lift anything heavier than a phone book, not to drive or drink alcohol while taking narcotic pain medication, and to resume all of her home medications, and to call her doctor or go to the nearest emergency room if she has fevers > 101.5 F, vomiting, or increased redness, swelling, or discharge from her incision.
|
Has this patient ever tried levaquin.
|
{
"answer_end": [
1511
],
"answer_start": [
1467
],
"text": [
"was started on three day course of levaquin."
]
}
|
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.
|
spironolactone
|
{
"answer_end": [
655
],
"answer_start": [
587
],
"text": [
"fluid overload and spironolactone was added to his diuretic regimen."
]
}
|
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 medication has the patient take for urinary tract infection
|
{
"answer_end": [
3134
],
"answer_start": [
3095
],
"text": [
"treating with antibiotics as necessary."
]
}
|
A 79-year-old male with history of non-insulin dependent diabetes, coronary artery disease, congestive heart failure, hypertension, chronic renal failure, and left toe amputation on 7/1/06 was admitted for debridement and antibiotics. An MRA on 10/3/06 demonstrated on the right a multifocal high-grade stenosis of the proximal, anterior tibial, the tibioperoneal trunk and the proximal, posterior tibial arteries and included peroneal artery at the midcalf, two-vessel runoff and on the left diffuse high-grade stenoses of the anterior tibial, posterior tibial arteries and occlusion of the peroneal artery in the dorsalis pedis. The patient presented with bleeding from the site of the left toe amputation beginning two weeks ago associated with throbbing pain, soreness, erythema and swelling and exacerbated blood pressure when walking and only treated by narcotics. Neuro and Psych: The patient has delirium postoperatively for which he was placed on soft restraints and received Zyprexa. Cardiac: Upon admission, potassium was noted to be elevated and the patient had EKG changes associated with hyperkalemia and received Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin for coronary artery disease related event prophylaxis. Blood pressure was controlled with isosorbide dinitrate, Norvasc, lisinopril, and Lopressor. Pulmonary: No events. Maintained oxygen saturation greater than 90% on room air. Renal: Creatinine was stable in the mid 3s and trended down to 2.6 at the time of discharge below his baseline of 4-5. Voiding without difficulty at the time of discharge. Maintained on his renal medications. FEN/GI: Tolerated regular diet. Lactulose and Colace to prevent constipation while taking narcotics, also had Dulcolax p.r.n. Zinc and Vitamin C was started per the Nutrition consult. Hematology: He received heparin for DVT prophylaxis. His hematocrit remained stable. He had some oozing from the right thigh but this resolved with a pressure dressing. ID: He was treated throughout his hospitalization with vancomycin, levofloxacin and Flagyl for methicillin-resistant Staphylococcus aureus that grew from the wound after the first and second irrigation and debridement. The levofloxacin and Flagyl were discontinued prior to discharge. He will continue his vancomycin at the time of discharge. Endocrine: Diabetes controlled. He was maintained on his Prandin and insulin sliding scale for glycemic control. He also received Vitamin D, Calcitriol, Nephrocaps, Epogen, and Aranesp. His incision remained clean, dry and intact without erythema or exudate. He was afebrile with stable signs at the time of discharge. ACTIVITY INSTRUCTIONS: He is nonweightbearing on the left lower extremity to protect the open toe. COMPLICATIONS: None. DISCHARGE LABS: Laboratory tests at the time of discharge include sodium 138, potassium 4.1, chloride 111, bicarbonate 21, BUN 35, creatinine 2.6, calcium 9.0, magnesium 1.9, vancomycin 19.5, white blood cell count 7.3, hemoglobin 9.9, hematocrit 30.2, platelets 221. DISCHARGE MEDICATIONS: His medications at discharge include aspirin 325 mg p.o. daily, vitamin C 500 mg p.o. b.i.d., calcitriol 0.5 mcg p.o. daily, Colace 100 mg p.o. daily, heparin 5000 units subcutaneous t.i.d., isosorbide dinitrate 10 mg p.o. t.i.d., lactulose 30 mL p.o. t.i.d., lisinopril 50 mg p.o. daily, Lopressor 50 mg p.o. q.6h., Prandin 0.5 mg p.o. with each meal, Aranesp 40 mcg subcutaneous every week, sliding scale insulin, insulin aspart 4 units, Tylenol p.r.n., Dilaudid 2-4 mg p.o. q.4h. as needed for pain, milk of magnesia as needed for constipation, Reglan for nausea, oxycodone for pain 5-10 mg p.o. q.4h. hours
|
What is the patient's current dose does the patient take of her calcitriol
|
{
"answer_end": [
3176
],
"answer_start": [
3116
],
"text": [
"vitamin C 500 mg p.o. b.i.d., calcitriol 0.5 mcg p.o. daily,"
]
}
|
A 31-year-old female with a history of Type 2 DM, morbid obesity, and borderline HTN was admitted to the MTCH ED for treatment of hyperglycemia due to poor diabetes management for an entire year and symptoms of polydipsia and polyuria, tingling in her fingers and toes, and worsening vision. Upon further examination, she was also diagnosed with a UTI. The discharge medications included LISINOPRIL 5 MG PO QD, POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, METFORMIN 1,000 MG PO BID, LEVOFLOXACIN 250 MG PO QD X 1 doses, LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, and an instruction to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. The patient was discharged with a goal blood glucose of less than 200 mg/dL, an increase of Lantus to 25 mg SC QD, an increase of Metformin to 1000 mg PO BID, and diabetes home medication regimen/glucometer/test strips. HTN: Lisinopril 5 mg PO QD was also prescribed. F/E/N: KCl PO replacement scale. MgSulfate sliding scale.GI: Colace PRN, MOM PRN, and diabetes education, checking sugars TID, self-FSBG checks, and a 30-45 min walk at least 5 times per week were also included in the treatment plan.
|
Previous kcl
|
{
"answer_end": [
1050
],
"answer_start": [
978
],
"text": [
"F/E/N: KCl PO replacement scale. MgSulfate sliding scale.GI: Colace PRN,"
]
}
|
This is a 42 year old female nurse with morbid obesity who was admitted on 0/25/95 due to concern for her being at high risk of skin breakdown and infection. A panniculectomy was performed by Dr. Stanczyk without any complications. During the hospital course, the patient was treated with MEDICATIONS: Paxil, 60 mg P O q AM; Diabeta, 5 mg P O q AM; Trazadone, 100 mg q h.s.; Ultram, 100 mg q 4-6 hours prn; Reglan, 10 mg q 6 hours prn nausea; Bactroban ointment b.i.d.; Lotrisone cream b.i.d. topically; Afrin nasal spray q 12 hours PRN; Proventil inhalers, two puffs PRN; IV Ancef t.i.d.; Hibiclenz showers and sub-q Heparin. Preoperatively, her pulmonary function was assessed and found to have an FEV-1 of 53% of predicted; FVC of 57% of predicted and an FEV-1/FVC of 93% of predicted. Postoperatively, the patient was transferred to the ICU and received two (2) units of autologous red blood cells and two (2) units of blood with a hematocrit reaching 29%. On postoperative day five, two of the four Jackson-Pratt drains were removed and the patient was discharged in good condition on postoperative day six with plans for home visiting nurse for dressing changes daily and P O Keflex while two Jackson-Pratt drains were in. The patient was prescribed DISCHARGE MEDICATIONS: 1) Keflex, 500 mg P O q.i.d.; 2) Percocet one to two P O q 4 hours prn pain; 3) Lotrisone topically, TP b.i.d.; 4) Paxil, 60 mg P O q AM; 5) Azmacort, four puffs inhaled q.i.d.; 6) Bactroban topically TP b.i.d.; 7) Diabeta, 5 mg P O q AM; 8) Ferrous Sulfate, 300 mg P O t.i.d.; 9) Proventil inhaler, two puffs inhaled q.i.d. for follow-up in outpatient clinic with Dr. Bartles in one (1) week.
|
has the patient had percocet
|
{
"answer_end": [
1355
],
"answer_start": [
1312
],
"text": [
"Percocet one to two P O q 4 hours prn pain;"
]
}
|
Arron Umbaugh was admitted on 4/30/2001 and discharged on 7/10/2001 with a code status of full code and disposition of home w/ services. The discharge medications included ASA (Acetylsalicylic Acid) 325 mg PO QD, Atenolol 25 mg PO QD Starting Today (1/24) HOLD IF, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 60 mg PO QD Starting Today (1/24) Instructions: Take 60mg per day for 3 days and then change, Zestril (Lisinopril) 7.5 mg PO QD, on order for KCL IMMEDIATE REL. PO (ref # 85723815) POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: will follow, on order for KCL SLOW REL. PO (ref # 68279429), COUMADIN (Warfarin Sodium) 6 mg PO QD, on order for ZOCOR PO (ref # 88249805) POTENTIALLY SERIOUS INTERACTION: WARFARIN & SIMVASTATIN, ZOCOR (Simvastatin) 20 mg PO QHS, on order for ERYTHROMYCIN TP (ref # 53201344) POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & ERYTHROMYCIN, TOPICAL OR OPHTHALMIC, Metformin 1,000 mg PO BID Starting Today (1/24), Prilosec (Omeprazole) 20 mg PO QD, with instructions to take consistently with meals or on empty stomach, and a warning for a potentially serious interaction: Furosemide & Omeprazole, Valacyclovir 1,000 mg PO Q8H X 7 Days, with Tylenol. Please page Dr. Blouir about your eye pain and come to the ED, lasix qd and see Dr. boeshore on wed. as well as daily weights, and to call Dr. Pradel if they can't control their pain due to zoster on your back. The patient was admitted with CHF exacerbation, increased SOB over past few days, orthopnea and PND, with left sided failure and diastolic dysfunction, and IV lasix 40 in ED, which decreased SOB. The patient was also prescribed Metformin 1000 mg PO BID, Prilosec (Omeprazole) 20 mg PO QD, and Valacyclovir 1000 mg PO Q8H X 7 Days with instructions to take consistently with meals or on empty stomach, and a warning for a potentially serious interaction: Furosemide & Omeprazole. Override Notices were added for COUMADIN PO (ref # 29560859), KCL IMMEDIATE REL. PO (ref # 85723815), KCL SLOW REL. PO (ref # 68279429), and ZOCOR PO (ref # 88249805) due to potentially serious interactions: Aspirin & Warfarin, Lisinopril & Potassium Chloride, Warfarin & Simvastatin, respectively. The patient was also instructed to take lasix qd and see Dr. boeshore on wed. as well as daily weights, and to call Dr. Pradel if they can't control their pain due to zoster on their back. The patient was discharged with discharge medications including ASA (Acetylsalicylic Acid) 325 mg PO QD, Atenolol 25 mg PO QD Starting Today (1/24) HOLD IF, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 60 mg PO QD Starting Today (1/24) Instructions: Take 60mg per day for 3 days and then change, Zestril (Lisinopril) 7.5 mg PO QD, COUMADIN (Warfarin Sodium) 6 mg PO QD with instructions to avoid high Vitamin-K containing foods, and ZOCOR (Simvastatin) 20 mg PO QHS with instructions to avoid grapefruit unless MD instructs otherwise.
|
Has the pt. ever been on coumadin before
|
{
"answer_end": [
1988
],
"answer_start": [
1955
],
"text": [
"for COUMADIN PO (ref # 29560859),"
]
}
|
This 57 year old female presented with a progressive right first toe wound for two months and was admitted to the vascular surgical service where she was placed on triple antibiotics and dressing changes. Her laboratory exams were within normal limits, her EKG was normal sinus rhythm, her AVI was 0.60 and 0.59 at the PT and PTT respectively on the way with mildly decreased PVRs. She had no signs of infection on her leg wounds and she did have some mild erythema around her right great toe which was improved after the patient was restarted on Ancef on postoperative day three. She underwent a right femoral tibial bypass graft and first toe amputation of the right foot and was discharged to home with services and home physical therapy and home visiting nurses. Her discharge medications included Enteric coated Aspirin 325 mg p.o. q d, Atenolol 50 mg p.o. q d, Atenolol 50 mg p.o. baid, Vasotec 20 mg p.o. q d, Glyburide 10 mg p.o. b.i.d., Percocet one to two tablets p.o. q 4 h p.r.n. pain, Vitamin B 100 mg p.o. b.i.d., multivitamin one tablet p.o. q d, Pravachol 60 mg p.o. q h.s., Glucophage 1000 mg p.o. t.i.d., and Keflex 500 mg p.o. q.i.d. x 7 days.
|
What types of medications have been tried for erythema management
|
{
"answer_end": [
580
],
"answer_start": [
499
],
"text": [
"was improved after the patient was restarted on Ancef on postoperative day three."
]
}
|
Mr. Almon is a 51 year old gentleman with history of insulin dependent diabetes mellitus and unstable angina who was doing yard work and experienced an episode of nausea and vomiting along with chest discomfort. His EKG was noted to have an old T wave inversion in lead 3 which was now upright and ST depressions that were normalizing, along with CKs of 974 and MB 24.3 and Troponin level of 1.77. He received aspirin 5 mg of intravenous Lopressor, Heparin drip and Adenosine MIBI. Cardiac catheterization revealed Right dominant system, no significant left main lesions identified, left anterior descending coronary artery with a discreet mid 65% lesion, distal 99% lesion and first diagonal coronary artery with a proximal discrete 70% lesion, left circumflex coronary artery with a distal after the second obtuse marginal discrete 60% lesion, supplying the second obtuse marginal. First marginal coronary artery had an ostial discrete 90% lesion and a second obtuse marginal had an ostial discrete 100% lesion. Right coronary artery had a mid discrete 95% lesion supplying the right posterior descending coronary artery. The patient underwent echocardiogram which revealed mild concentric left ventricular hypertrophy with normal cavity size and left ventricular systolic function mildly reduced with an estimated ejection fraction of 45%, severe hypokinesis of the basal and mid segments of the inferior wall and inferior septum, and severe hypokinesis of the posterior wall, apex and distal anterior wall. He underwent coronary artery bypass graft x 3 with a left internal mammary artery to left anterior descending artery, saphenous vein graft to the obtuse marginal coronary artery and saphenous vein graft to the intermediate coronary artery. Postoperatively, he was extubated on postoperative day number one and transferred to the step down unit, with a T.max of 99. He had serous drainage from the inferior aspect of his sternal incision. He was started on Keflex 500 mg four times a day for 10 days. Discharge medications included Enteric coated aspirin 325 mg once a day, ibuprofen 200 to 800 mg every 4 to 6 h p.r.n. pain, NPH Humulin insulin 44 units in the morning, 14 units in the evening, regular insulin 6 units twice a day, Niferex 150 mg twice a day, potassium chloride 20 mEq once a day, Zocor 40 mg once in the evening, Atenolol 50 mg once a day, Lisinopril 10 mg once a day, Keflex 500 mg four times a day for 10 days for his superficial sternal wound infection and torsemide 60 mg twice a day, and he was discharged to home in stable condition.
|
Is the patient currently or have they ever taken heparin
|
{
"answer_end": [
481
],
"answer_start": [
398
],
"text": [
"He received aspirin 5 mg of intravenous Lopressor, Heparin drip and Adenosine MIBI."
]
}
|
Patient DOUGLASS W. DILEO was admitted to CAR with unstable angina and discharged on 11/23/04 with a code status of full code and disposition of home w/ services. The patient has a possible allergy to NSAIDs with reaction unknown and a probable allergy to SIMVASTATIN, NSAIDs, SHELLFISH, and Codeine. The patient was given atropine and Fem stop placed over cath due to femoral hematoma. CT ruled out retroperitoneal bleed and her HCT dropped from 32 to 26, and she was transfused 2 U PRBC. The anti-ischemic regimen at discharge included ENTERIC COATED ASA (ASPIRIN ENTERIC COATED) PO 325 MG QD (ref #57541802), INSULIN NPH HUMAN 36 UNITS QAM; 40 UNITS QPM SC, NEURONTIN (GABAPENTIN) 600 MG PO BID, PLAVIX (CLOPIDOGREL) 75 MG PO QD, ZETIA (EZETIMIBE) 10 MG PO QD, LISINOPRIL 40 MG PO QD, HYDROCHLOROTHIAZIDE 25 MG PO QD, PREVACID (LANSOPRAZOLE) 30 MG PO QD, GLUCOPHAGE (METFORMIN) 1,000 MG PO BID, and ATENOLOL 25 MG PO QD, with no statin due to muscle pain history. The patient was instructed to take 1/2 their regular home dose of Atenolol until they see their cardiologist/PCP, and to follow a diet of house/low chol/low sat. fat and house/ADA 2100 cals/dy. Patient was to follow up with Dr. Brechbiel in 2 weeks and Dr. Damms for right leg ultrasound in 2-4 weeks. The patient also had a below-the knee right tibial vein DVT, was not anticoagulated for this below-the knee clot because of low risk of embolization and her recent HCT drop/hematoma. The patient was also given IBUPROFEN 600-800 MG PO Q6H PRN Pain for left knee pain after a fall one week prior. The patient was instructed to continue home diabetic regimen and followup with PCP/cardiology and schedule a repeat right leg ultrasound test (“LENI”) to follow the small blood clot in her leg in the future.
|
Has the patient ever tried statin
|
{
"answer_end": [
966
],
"answer_start": [
924
],
"text": [
"with no statin due to muscle pain history."
]
}
|
The patient was admitted on 5/5/2006 with a history of mechanical fall, with the attending physician being Dr. Clemente Armand Bolstad, with a full code status and disposition of Rehabilitation. Medications on Admission included Amiodarone 100 QD, Colace 100 bid, lasix 40mg QD, Glyburide 5mg bid, Plaquenil 200mg bid, Isordil 20mg tid, Lisinopril 20mg QD, Coumadin 5mg 3dys/week, 2.5mg 4dys/week, Norvasc 10mg QD, Neurontin 300mg TID, with APAP prn. An override was added on 10/2/06 by Gerad E. Dancy, PA for POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & WARFARIN with the reason for override being monitoring. The patient was rehydrated with IVF and PO's were encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable dose. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache. A CT pelvis showed a right adnexal cyst which will need further characterization by US and outpatient follow up. The patient has an extensive cardiac history and the fall is not likely related to a cardiac issue as it appears mechanical, with no syncope, chest pain, etc. She was diagnosed with an NSTEMI with a small TnI leak, likely demand related in the setting of hypovolemia and the fall. Enzymes trended down. She was dry on admission and rehydrated with IVF, PO's encouraged, and became euvolemic by 1/2. Her JVP was up to 12cm, although it was difficult to gauge her volume status due to TR. She had a prolonged QT on admission, on telemetry, of unclear etiology, possibly starvation. This was monitored on telemetry until ROMI and drugs that confound were avoided. The QTc resolved to low 500s and a DDD pacer was functioning with V-pacing at 60bpm. Additional medications included NATURAL TEARS (ARTIFICIAL TEARS) 2 DROP OU BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, PLAQUENIL SULFATE (HYDROXYCHLOROQUINE) 200 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP <110, MILK OF MAGNESIA (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO DAILY PRN Constipation, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM, NORVASC (AMLODIPINE) 10 MG PO DAILY HOLD IF: SBP <110, NEURONTIN (GABAPENTIN) 300 MG PO TID, NEXIUM (ESOMEPRAZOLE) 20 MG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, DULCOLAX RECTAL (BISACODYL RECTAL) 10 MG PR DAILY PRN Constipation, CLOTRIMAZOLE 1% TOPICAL TOPICAL TP BID, GLYBURIDE 5 MG PO BID, LASIX (FUROSEMIDE) 20 MG PO DAILY, and corrected pt restarted on lasix 20 qd on d/c. A PT consult was obtained 3/21 and to follow daily at rehab. Labs showed Na 146, CK 3320, CKMB 12.9, Trop 0.23--->0.10, AST 107, Cr 1.2-->1.6. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache, rehydrated with IVF, po's encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable
|
has there been a prior norvasc
|
{
"answer_end": [
414
],
"answer_start": [
337
],
"text": [
"Lisinopril 20mg QD, Coumadin 5mg 3dys/week, 2.5mg 4dys/week, Norvasc 10mg QD,"
]
}
|
This is a 72 year old black female with a history of hypertension, angina, adult onset diabetes, and recurrent syncopal events who was treated with Dilantin for less than a year in 1970 and her last episode was in 1989. She was given Nitro Paste and 1 amp of D50 when she experienced a syncopal event on the morning of admission and her fingerstick glucose was checked. Her medications on admission include aspirin one tablet q d, Questran one pack q d, Micronase 5 mg po q d, Betaxolol eye drops bid to each eye, Pilocarpine eye drops tid to each eye, and eye drops bid to each eye. She also receives monthly Vitamin B12 injections and takes nitroglycerin with chest pain. Physical examination revealed pinpoint constriction of her pupils secondary to her glaucoma eyedrops, bibasilar, coarse crackles in the chest, no jugular venous distention, and nonfocal neurologic exam. Laboratory data includes sodium of 143, potassium of 4.3, chloride of 109, bicarbonate of 20, BUN of 21, creatinine of 1.0, glucose of 160, hematocrit of 43.4, white count of 6.45, and normal coagulation factors. Chest X ray showed a calcific aorta, C spine X ray and head CT were negative, and EKG showed no changes from her baseline. The patient was started on Isordil and Lopressor empirically but these were discontinued and her chest pain is relieved with nitroglycerin. She was discharged to home with plans for a repeat 24 hour Holter as an outpatient with diagnoses of syncope, borderline type II diabetes, stable exertional angina, and glaucoma. Discharge medications include aspirin one tablet po q d, Questran one package po q d, Pilocarpine eye drops tid per eye, Betaxolol eye drops bid per eye, eye drops bid per eye, sublingual nitroglycerin prn chest pain, and Naprosyn 375 mg tid prn.
|
naprosyn
|
{
"answer_end": [
1778
],
"answer_start": [
1754
],
"text": [
"Naprosyn 375 mg tid prn."
]
}
|
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 there been a prior levoxyl ( levothyroxine sodium )
|
{
"answer_end": [
355
],
"answer_start": [
311
],
"text": [
"LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD,"
]
}
|
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
|
nephrocaps
|
{
"answer_end": [
1713
],
"answer_start": [
1649
],
"text": [
"Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d.,"
]
}
|
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure.
|
Has the patient had previous atenolol
|
{
"answer_end": [
792
],
"answer_start": [
764
],
"text": [
"Atenolol 25 milligrams q.d.,"
]
}
|
Patient SAMU, CURTIS 759-74-53-9 is a 61-year-old female with multiple medical problems including dilated CMP, s/p chemo and XRT for Breast CA, CAD, s/p MI, COPD, and occasional O2 use. On admission, her VS are T97.8, HR73, BP113/71, RR18, and O2Sat 92%. She presents with dry cough associated with SOB x 2 days and increased DOE after 1/2 block, orthopnea and PND, chronic abd pain, increased Alk Phos, increased bloating, and wheezing without increased O2 need at night. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #29937145) with POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, DIGOXIN 0.125 MG PO QD, on order for LEVOTHYROXINE SODIUM PO (ref #13700176) with POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, COLACE (DOCUSATE SODIUM) 100 MG PO BID, FERROUS SULFATE 325 MG PO BID, MOTRIN (IBUPROFEN) 600 MG PO Q8H Starting Today (10/7) with PRN Pain Food/Drug Interaction Instruction Take with food, REGLAN (METOCLOPRAMIDE HCL) 5 MG PO AC, SIMETHICONE 80 MG PO QID, VITAMIN B1 (THIAMINE HCL) 100 MG PO QD, TRAZODONE 50 MG PO HS, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & WARFARIN, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: aware, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, GABAPENTIN 200 MG PO QD, TORSEMIDE 100 MG PO BID, COZAAR (LOSARTAN) 50 MG PO QD, LEVOCARNITINE 1 GM PO QD Starting Today (8/21), CITALOPRAM 20 MG PO QD, ADVAIR DISKUS 250/50 (FLUTICASONE PROPIONATE/...) 1 PUFF INH BID, NEXIUM (ESOMEPRAZOLE) 20 MG PO QD, LANTUS (INSULIN GLARGINE) 60 UNITS SC QHS, NOVOLOG (INSULIN ASPART), LIPITOR (ATORVASTATIN) 10 MG PO QPM, ATORVASTATIN CALCIUM, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and Sliding Scale (subcutaneously) SC AC with Food/Drug Interaction Instructions to Avoid milk and antacid, Take with food, Take consistently with meals or on empty stomach, and If BS is less than 125, then give 0 units subcutaneously. The patient was placed on order for COUMADIN PO (ref #29937145) and Adriamycin induced CMP HTN IDDM Sarcoid for DVT on 0/29 (goal 2-3). She was placed on po levofloxacin for 7 days and symptoms resolved. Her weight was 227lbs 7/6/05 (dry weight ~200), and she was on torsemide 100mg bid at baseline, with po lasix increased to 200bid x 2 doses, and zaroxyln 5mg po BID x 6 doses added. Tests included ALK Phos: 627, ALT: 71, AST: 65, Card Enzymes: neg, WBC: 6.4, UA: 1.011, 1+prot, 5-10WBC, 2+bact, CXR: LLL opacity, seen best on lateral view, EKG: prolonged PR, q in AVL, flat Ts laterally, unchanged from 9/5, RUQ US: sludge, gall bladder wall thickened 8mm, neg sonographic Murphy's sign, 2/4 Echo
|
What is the current dose of the patient's trazodone
|
{
"answer_end": [
1082
],
"answer_start": [
1060
],
"text": [
"TRAZODONE 50 MG PO HS,"
]
}
|
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.
|
What is the patient's current dose does the patient take of her zestril ( lisinopril )
|
{
"answer_end": [
358
],
"answer_start": [
324
],
"text": [
"ZESTRIL (Lisinopril) 2.5 MG PO QD,"
]
}
|
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.
|
has the patient used enteric-coated aspirin in the past
|
{
"answer_end": [
743
],
"answer_start": [
694
],
"text": [
"including enteric-coated aspirin 81 mg p.o. q.d.,"
]
}
|
Harrison Fullwood was admitted on 4/3/2005 for ICD placement for HCM. On 7/13/05, Medtronic Dual Chamber DDI/ICD was placed under general anesthesia with a CODE STATUS of Full Code and disposition of Home. ECHO 5/13 showed septal thickness 16mm, posterior wall thickness 19mm with preserved EF 65% and LV outflow tract peak gradient 125mmHg. Holter monitoring 0/2 without any arrhythmias. On admission PE, VS 96.4 74 140/90 20 93% RA. Labs/Studies included CBC, BMP, Coags wnl, EKG NSR. TW flat V5/V6 (old), CXR (portable): cardiomegaly, no e/o ptx, PA/lat CXR AM after no ptx, leads in place, no overt failure. The patient was prescribed Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid, Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily (inc to 40 or 60 during period), Kcl 20meq daily, Verapamil 120mg daily, Patanol 1-2 OU bid prn, Loratidine 10mg daily, Zocor 20mg qhs, Effexor 75mg daily, Metformin 1250mg bid, Mgoxide 500mg daily, Ambien prn, Amox prior to procedures. On order for Motrin PO (ref# 234611479), the patient had a POSSIBLE allergy to Aspirin; reaction is Unknown. The patient was instructed to take Keflex for a 3 day total course, take all medications with food, and avoid grapefruit unless MD instructs otherwise. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. ENDO: ISS. restarted Metformin on morning of d/c. NEURO: cont Effexor. On discharge, the patient was prescribed Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Wheezing, Lasix (Furosemide) 20 mg PO QD Starting Today (10/19) with instructions to titrate his dose 20mg/40mg/60mg as he normally does depending on his degree of swelling, Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache, Magnesium Oxide 560 mg PO QD, Verapamil Sustained Release 120 mg PO QD Starting Today (10/19) with instructions to confirm home dose and resume home dose, Keflex (Cephalexin) 250 mg PO QID X 10 doses, Zocor (Simvastatin) 20 mg PO QHS, Ambien (Zolpidem Tartrate) 10 mg PO QHS PRN Insomnia, Loratadine 10 mg PO QD, Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid, Metformin 1,250 mg PO BID Starting IN AM (10/19), Rhinocort Aqua (Budesonide Nasal Inhaler) 2 Spray Inh BID, Singulair (Montelukast) 10 mg PO QD, Effexor XR (Venlafaxine Extended Release) 75 mg PO QD Number of Doses Required (approximate): 5, Advair Diskus 250/50 (Fluticasone Propionate/...) 1 Puff Inh BID, Nexium (Esomeprazole) 40 mg PO QD, Oxycodone 10 mg PO Q4H PRN Pain, and Atrovent HFA Inhaler (Ipratropium Inhaler) 2 Puff Inh QID. November of 2004, HF symptoms were controlled on Lasix and at baseline he could work. The patient was also advised to take all medications with food and to avoid grapefruit unless MD instructs otherwise, and to take Keflex for a 3 day total course and to take all other medications as the same. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A.
|
What is the dosage of potassium chloride
|
{
"answer_end": [
2267
],
"answer_start": [
2192
],
"text": [
"Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid,"
]
}
|
Shaull Darin was admitted on 8/12/2007 and discharged on 7/17/2007 with a full code status and disposition to home. During his stay, he was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, with an Override Notice added on 10/30/07 by LAUB , STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) due to a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, ATENOLOL 37.5 MG PO DAILY, CAPTOPRIL 12.5 MG PO BID, on order for KCL IMMEDIATE RELEASE PO ( ref # 545368405 ) due to a POTENTIALLY SERIOUS INTERACTION: CAPTOPRIL & POTASSIUM CHLORIDE, CELEXA ( CITALOPRAM ) 40 MG PO DAILY, PLAVIX ( CLOPIDOGREL ) 75 MG PO DAILY, DIGOXIN 0.125 MG PO DAILY, EPLERENONE 25 MG PO DAILY, FOLATE ( FOLIC ACID ) 1 MG PO DAILY, LASIX ( FUROSEMIDE ) 60 MG PO BID, Alert overridden: Override added on 10/30/07 by GOODWINE , BUFORD H B. , M.D. on order for LASIX PO ( ref # 145213873 ), NEURONTIN ( GABAPENTIN ) 100 MG PO TID, LORAZEPAM 0.5 MG PO DAILY PRN Anxiety, LOVASTATIN 40 MG PO DAILY, with an Override Notice added on 10/30/07 by PERAULT , SHELBY H M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) due to a POTENTIALLY SERIOUS INTERACTION: LOVASTATIN & WARFARIN, POTENTIALLY SERIOUS INTERACTION: NIACIN , VIT. B-3 & LOVASTATIN, OMEPRAZOLE 20 MG PO DAILY, TEMAZEPAM 15-30 MG PO BEDTIME PRN Insomnia, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, COSOPT ( TIMOLOL/DORZOLAMIDE ) 1 DROP OU BID, Alert overridden: Override added on 11/14/07 by LUTHY , LANNY D E. , M.D. on order for COSOPT OU ( ref # 517414331 ), COUMADIN ( WARFARIN SODIUM ) 1 MG PO QPM, TRAVATAN 1 DROP OU BEDTIME Instructions: OU. thanks., amiodarone toxicity, Peripheral neuropathy, restless legs, Spinal, ASA/Plavix, BB. Some concern for ischemia causing his, to 60 bid. Cont Dig/nitrate/BB, ACEi. Checked echo, no change., Rhythym: Tele. Lyte replete78M with significant CAD, iCM EF 15-20%, presenting with SOB, underwent Adenosine MIBI with no focal defects, LHC with no new disease and no interventions, RHC with wedge of 16, PFTs 1992 with no COPD, CR 1.4-1.8, Barrett's on PPI, neuropathy, neurontin, celexa, glaucoma on eye drops, CV, NAS, 2L fluid restrict diet, held coumadin for cath then restarted it with 2mg on 8/1, 1mg on 6/10, INR of 1.7 on d/c, additional comments included measuring daily weights and calling MD if weight increases by more than 5 lbs in one week or 2-3 lbs in one day, continuing coumadin and checking INR on Monday, taking lasix 60 twice a day, and resuming all home medications. Patient discharged in stable condition with instructions to follow up volume status and check INR on 2/21/07. Number of Doses Required ( approximate ): 7. Override Notice: Override added on 10/30/07 by LAUB, STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) and Alert overridden: Override added on 11/14/07 by LUTHY , LANNY D E. , M.D. on order for
|
has there been a prior coumadin
|
{
"answer_end": [
2781
],
"answer_start": [
2680
],
"text": [
"Override added on 10/30/07 by LAUB, STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 )"
]
}
|
Ms. Heit is a 67-year-old female who received a heart transplant in March 2006 and was transferred from an outside hospital after sustaining a right hip fracture. On admission, her plain films revealed a nondisplaced right femoral fracture and her EKG showed sinus tachycardia. She was given MEDICATIONS ON ADMISSION: Neoral 150 mg b.i.d., prednisone 8 mg daily, CellCept 1500 mg b.i.d., Protonix 20 mg daily, Pravachol 40 mg daily, diltiazem 360 mg daily, multivitamin one daily, magnesium oxide 400 mg daily, calcium and vitamin D 1800 mg daily, Fosamax weekly on Mondays, Colace 100 mg daily, Zocor 20 mg daily, Dulcolax 10 mg as needed for constipation, vitamin E 400 units daily, and vitamin C 500 mg b.i.d. She had a history of heparin-induced thrombocytopenia, which was treated with fondaparinux daily prior to the procedure and then discharged on aspirin for four weeks postprocedure. She underwent a dynamic hip screw procedure which was uncomplicated and allowed her to begin weightbearing on postoperative day 1, and was transfused with 2 units of packed red blood cells on the day after surgery with appropriate hematocrit rise. She received additional 2 units of packed red blood cells prior to discharge. DISCHARGE MEDICATIONS: Tylenol 650 mg every four hours as needed for pain, Protonix 40 mg daily, Pravachol 40 mg daily, Neoral (cyclosporine) 150 mg b.i.d., diltiazem extended release 360 mg daily, Caltrate plus D one tablet daily, Neoral (cyclosporine) 150 mg b.i.d., diltiazem extended release 360 mg daily, Fosamax 70 mg weekly, Dulcolax p.r. 10 mg as needed for constipation, and oxycodone 5-10 mg every six hours as needed for pain. She will continue her home medication regimen, be maintained on aspirin 325 mg for four weeks to prevent clot formation postsurgery, and take oxycodone as needed for pain. She has a followup appointment with orthopedic surgery, and will also be closely followed by transplant clinic in the Angeles with a walker and should continue aspirin 325 mg daily.
|
has the patient had calcium
|
{
"answer_end": [
547
],
"answer_start": [
481
],
"text": [
"magnesium oxide 400 mg daily, calcium and vitamin D 1800 mg daily,"
]
}
|
A 31-year-old female with a history of Type 2 DM, morbid obesity, and borderline HTN was admitted to the MTCH ED for treatment of hyperglycemia due to poor diabetes management for an entire year and symptoms of polydipsia and polyuria, tingling in her fingers and toes, and worsening vision. Upon further examination, she was also diagnosed with a UTI. The discharge medications included LISINOPRIL 5 MG PO QD, POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, METFORMIN 1,000 MG PO BID, LEVOFLOXACIN 250 MG PO QD X 1 doses, LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, and an instruction to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. The patient was discharged with a goal blood glucose of less than 200 mg/dL, an increase of Lantus to 25 mg SC QD, an increase of Metformin to 1000 mg PO BID, and diabetes home medication regimen/glucometer/test strips. HTN: Lisinopril 5 mg PO QD was also prescribed. F/E/N: KCl PO replacement scale. MgSulfate sliding scale.GI: Colace PRN, MOM PRN, and diabetes education, checking sugars TID, self-FSBG checks, and a 30-45 min walk at least 5 times per week were also included in the treatment plan.
|
Has this patient ever been prescribed lantus ( insulin glargine )
|
{
"answer_end": [
582
],
"answer_start": [
541
],
"text": [
"LANTUS (INSULIN GLARGINE) 20 UNITS SC QD,"
]
}
|
Ms. Hesby is a 36-year-old woman with very poorly controlled type 1 diabetes, end-stage renal disease, right eye blindness, lower extremity neuropathy, gastroparesis, and a history of extensive infections. She presented to Path Community Hospital with a right thigh burn and infection, and was given a prescription for antibiotics, 20 units of IV insulin, 500 mL normal saline boluses, and several 250 mL boluses, as well as 2 amps of calcium gluconate, Kayexalate, albuterol nebs, and Augmentin and IV vancomycin for her right thigh cellulitis. For long-term management, she was prescribed Lantus 24 units subcu each night, NovoLog sliding scale, PhosLo, Nephrocaps, Vitamin D, Sevelamer 1600 t.i.d., Toprol 100 mg p.o. daily, Lisinopril 5 mg p.o. daily, Plavix 75 mg p.o. daily, Keppra 500 mg p.o. b.i.d., Flovent two puffs b.i.d., Albuterol p.r.n., Baclofen 5 mg p.o. t.i.d., and Ambien 10 mg p.o. at bedtime p.r.n. The patient was admitted with a diagnosis of Diabetic Ketoacidosis (DKA) and was stabilized in the MICU on an insulin waves. She was then transitioned to NPH and finally to Lantus 24 units subcu and her hypertension is being managed on her home dose of Lopressor 25 q.i.d. and switched to Captopril, which is being titrated. Her area of cellulitis has completely resolved, and if she becomes acidotic, the patient can be managed with sodium bicarbonate and D5W in small boluses. The patient is taking her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d., however she has consistently refused her heparin. Of note, on the night of 1/26/06, the patient complained of severe cramping, right lower quadrant pain, which is new. She noted this pain has increased rapidly in the setting of diarrhea. Several C. diff studies, which were sent recently have been negative and the patient has had no blood in her diarrhea. Presumed cause is Augmentin, which has been stopped. The patient has continued to eat freely and is passing diarrhea despite her complaints of 10/10 severe abdominal pain. A CT scan of her abdomen was ordered, but she refused to take oral or IV contrast. The results of this CT scan are pending and will be followed up by the new medical team.
|
What was the dosage prescribed of baclofen
|
{
"answer_end": [
878
],
"answer_start": [
852
],
"text": [
"Baclofen 5 mg p.o. t.i.d.,"
]
}
|
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.
|
Is there history of use of bactrim
|
{
"answer_end": [
623
],
"answer_start": [
536
],
"text": [
"switch to PO linezolid since the pt refused to take bactrim stating allergy to the med."
]
}
|
Mr. Neilsen is a 59-year-old morbidly obese man with a history of morbid obesity, paroxysmal atrial fibrillation, ejection fraction of 40 percent, obstructive sleep apnea on continuous positive airway pressure, history of cellulitis, and presenting with progressive lower extremity weakness bilaterally and urinary incontinence. On admission, EMG showed decreased recruitment in the tibialis anterior and gastrocnemius bilaterally, and he was treated with seven days of Bactrim for resolution of his incontinence and he was not anticoagulated at the moment though Coumadin should be a consideration given his risk of stroke. Two weeks prior to admission he noted some lumbar and sacral pain, nonradiating, worse while moving his right leg, and increasing urinary frequency without burning or urinary incontinence. On the night of admission, while getting up from a chair, his right leg gave out and he fell to the floor without injury or head trauma. His laboratory data on admission showed sodium 140, potassium 4.5, chloride 102, bicarbonate 26, BUN 20, creatinine 0.9, glucose 101, white blood cell count of 9 with 76 polys, 4 bands, hematocrit 37.6 and platelet count of 236, and urinalysis showed 3+ blood and positive leukocyte esterase with 15-20 white blood cells, one plus bacteria and one plus squamous cells. He was started on a trial of Lasix p.o. q day to decrease his peripheral edema to help him with rehabilitation, and he was instructed to apply Nystatin powder for his pannus rash. His medications on discharge included Aspirin 325 mg p.o. q day, Colace 100 mg p.o. b.i.d., Lasix 40 mg p.o. q a.m., Indomethacin 25 mg p.o. t.i.d. p.r.n. pain, Lisinopril 15 mg p.o. q day, multivitamin one tablet p.o. q day, Bactrim DS one tablet p.o. t.i.d., Tamsulosin 0.4 mg p.o. q day, and Miconazole 2% topical powder b.i.d., and he was discharged to rehabilitation care for leg strengthening in a stable condition.
|
What medications has the patient been prescribed for pain
|
{
"answer_end": [
1660
],
"answer_start": [
1617
],
"text": [
"Indomethacin 25 mg p.o. t.i.d. p.r.n. pain,"
]
}
|
This 60-year-old male presented with a two week history of paroxysmal nocturnal dyspnea and dyspnea on exertion, possibly related to stress from the recent death of the patient's sister-in-law. His past medical history was significant for hypertension of approximately 10 years, non-insulin dependent diabetes mellitus of approximately 12 years, left Bell's palsy in 1985 treated with prednisone, and type IV hypolipoproteinemia. An EKG showed new anterolateral changes since the EKG taken a year earlier, and he was admitted with a diagnosis of Myocardial Infarction, Congestive Heart Failure, and Hypertension. His medications included Micronase 10 mg po bid, Persantine 60 mg po tid, aspirin one po q d, Lisinopril 5 mg po q d, and Atenolol 50 mg po q d. He had a 20 pack year history of smoking and social ethanol consumption. The patient was managed with gentle Lasix diuresis and the beta blocker was held due to concern for wall motion abnormalities. He was anticoagulated on heparin and loaded on Coumadin, and his medications on discharge included Lasix 40 mg po q d, Captopril 37.5 mg po tid, Ecotrin 325 mg po q d, Coumadin 5 mg po q h.s., magnesium oxide two tablets po q d, Isordil 10 mg po tid with meals, and Micronase 10 mg po bid. The patient was stable on discharge and was to follow up with Dr. Luciano Catignani in his office on Tuesday, 15 of October, at 3 p.m.
|
Has the patient ever tried heparin
|
{
"answer_end": [
1014
],
"answer_start": [
958
],
"text": [
"He was anticoagulated on heparin and loaded on Coumadin,"
]
}
|
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 chemo
|
{
"answer_end": [
1311
],
"answer_start": [
1250
],
"text": [
"enteritis and recent chemo, she required multiple further RBC"
]
}
|
A 45-year-old male with morbid obesity presented with chest pain and hypertensive urgency. He was ruled out for MI with negative serial enzymes and EKGs and a cardiac PET showed 2 small areas of reversible ischemia in the mid PDA and distal LAD territory. For CV treatment, he was given Aspirin 81mg PO daily, beta blocker, and HCTZ 25mg PO daily and Atenolol 50mg PO daily for HTN control. For Pulmonary issues, he had very mild asthma exacerbation and a restrictive ventilatory defect from obesity and was given Advair 500/50 BID, Albuterol Nebulizer 2.5 mg neb q2h, Albuterol Inhaler 2 puff inh qid PRN Shortness of Breath and prednisone 60mg QD x 3 doses. For GI issues, he had trace guaiac+ stool and a viral gastroenteritis causing diarrhea and some nausea. For endocrine issues, his A1C was 7.4 and he was educated on low sugar, low carbohydrate diet. For prevention, he was given Lovenox BID. Additional comments included taking HCTZ 25mg daily and Atenolol 50mg daily for blood pressure, eating a low sugar, low carbohydrate diet, and follow-up with cardiology on 11/0. He was discharged in a stable condition with a recommendation for monitor blood sugars and A1C, outpatient colonoscopy, and consider statin therapy, as well as Fluticasone Propionate/Salmeterol 250/50 1 puff inh BID, Albuterol Inhaler 2 puff inh QID, Artificial Tears 2 drop OD TID, Loratadine 10 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Albuterol Nebulizer 2.5 mg neb q4h, Acetylsalicylic Acid 81 mg PO daily, and Miconazole Nitrate 2% powder topical TP daily.
|
has there been a prior miconazole nitrate 2% powder
|
{
"answer_end": [
1600
],
"answer_start": [
1554
],
"text": [
"Miconazole Nitrate 2% powder topical TP 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.
|
Previous gemfibrozil
|
{
"answer_end": [
476
],
"answer_start": [
409
],
"text": [
"Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d.,"
]
}
|
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 previous ativan
|
{
"answer_end": [
823
],
"answer_start": [
728
],
"text": [
"Metformin 500 mg PO BID, Micronase 10 mg PO BID, Tylenol with Codeine PRN, and Ativan 5 mg PRN."
]
}
|
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 ever tried pain medicines
|
{
"answer_end": [
2025
],
"answer_start": [
1983
],
"text": [
"the patient was on several pain medicines,"
]
}
|
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