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GOMEY , REGGIE 802-36-83-4, a 70-year-old female with known CAD, DM, and schzioaffective disorder, presented with intermittent chest pain for 12 hours, with diaphoresis and no nausea/vomiting/fever/cough/shortness of breath. She had a recent cardiac workup with a moderate defect in the circumflex, but decided against medical treatment. Upon discharge, the patient was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, ATENOLOL 12.5 MG PO QAM HOLD IF: SBP<100 or HR<50, LIPITOR (ATORVASTATIN) 80 MG PO DAILY, COGENTIN (BENZTROPINE MESYLATE) 1 MG PO QAM, THORAZINE (CHLORPROMAZINE HCL) 400 MG PO QAM (on order, ref # 417100958) with a potentially serious interaction with Benztropine Mesylate and Chlorpromazine HCL, ECASA 325 MG PO DAILY, GLIPIZIDE XL 10 MG PO DAILY, SYNTHROID (LEVOTHYROXINE SODIUM) 100 MCG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP<100, METFORMIN 1,000 MG PO BID HOLD IF: NPO, and TRAZODONE 50 MG PO BEDTIME PRN Insomnia. CVD ROMI x2 with troponin and ck and CKMB were normal and the patient continued her cardiac medications for BP control and ECG showed early R wave but no ST changes. DM was managed with oral hypoglycemics and the patient was prescribed Heparin for prophylaxis. She was also prescribed a diet of House/Low chol/low sat. fat and 2 gram Sodium and given instructions to walk as tolerated. Follow up appointments were scheduled with Dr. Mike Kalafarski on 10/1/06.
|
Has the patient ever tried chlorpromazine hcl
|
{
"answer_end": [
715
],
"answer_start": [
696
],
"text": [
"Chlorpromazine HCL,"
]
}
|
Mr. Mauras is a 72-year-old man with history of stable angina, type 2 diabetes, peripheral vascular disease, former smoking history, and history of seizure disorder with cataracts. He had occasional anginal symptoms prior to discharge and took about two nitroglycerins per week. Over the past week, he had escalating chest pain requiring one nitroglycerin per day. The pain was relieved by rest and nitroglycerin. One week prior to admission, his digoxin was stopped and his amiodarone was decreased. His Plavix was stopped and his Coumadin was held. On the morning of admission, he had chest pain and received Lopressor, Enalapril, Lovenox treatment dose and a Plavix load in the ED. He was found to have flash pulmonary edema and in atrial fibrillation with rapid ventricular response and was taken back to the catheterization lab and given four stents to his saphenous vein graft, OM1 with good resolution of his symptoms. He was transferred to the floor and was given an amiodarone load given his ejection fraction and increased ectopy on telemetry. His troponin had been trended down to the 0.2s by discharge and his beta-blocker and ACE inhibitor were titrated to heart rate and blood pressure. Prior to anticipated discharge, he re-developed flash pulmonary edema secondary to atrial fibrillation with rapid ventricular response and was re-loaded with digoxin. He was started on Mucomyst precath with good effect, had a difficult-to-place Foley, and was started on Flomax with good effect. His creatinine on discharge was 1.2, his metformin was held, and he was continued on Lantus with sliding scale insulin. He was given three units of packed red blood cells given his history of CAD and was prescribed with Amiodarone 200 mg, Enteric-coated aspirin 325 mg, Librium 10 mg, Colace 200 mg, Ferrous gluconate 324 mg, Lasix 40 mg, Nitroglycerin one tab, Dilantin 100 mg, Senna two tabs, Coumadin 3 mg, Lipitor 80 mg, Flomax 0.4 mg, Plavix 75 mg, Lantus 14 units, Metformin 500 mg, Ranitidine 150 mg, Digoxin 0.125 mg, Enalapril 10 mg, and Atenolol 50 mg, with follow-up appointments with his PCP, Dr. Kelley Hernon of Electrophysiology on 7/8/05, and Dr. Daft on 9/20/05, and INR checked on 8/4/05 or 7/8/05 with Coumadin adjusted accordingly.
|
Previous mucomyst
|
{
"answer_end": [
1452
],
"answer_start": [
1386
],
"text": [
"Mucomyst precath with good effect, had a difficult-to-place Foley,"
]
}
|
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.
|
Did the patient receive indomethacin for pain
|
{
"answer_end": [
1660
],
"answer_start": [
1617
],
"text": [
"Indomethacin 25 mg p.o. t.i.d. p.r.n. pain,"
]
}
|
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.
|
lipitor
|
{
"answer_end": [
2377
],
"answer_start": [
2288
],
"text": [
"Lipitor 80 mg daily, Flomax 0.4 mg QD, potassium chloride slow release 10 mEq QD x3 doses"
]
}
|
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o.
|
What is the dosage of zocor
|
{
"answer_end": [
1235
],
"answer_start": [
1177
],
"text": [
"Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m.,"
]
}
|
The patient is a 54-year-old man with nonischemic dilated cardiomyopathy who presents with weight gain, weakness, and azotemia. He was admitted with decompensated heart failure and was treated with dobutamine, seretide, and diuretics with good effect, functioning on ACE inhibitor. Two weeks prior to presentation, Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg t.i.d., torsemide was being held, Coumadin 1 mg q.d., carvedilol 3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage, and glyburide were administered. On 2/19/03, Diuril was added to his regimen and his creatinine was noted to increase from 2.6 to 3.6 and diuretics were subsequently held. The patient was loaded on amiodarone, unfortunately still required low dose dobutamine to maintain his cardiac output and was transferred back to the floor and continued to have decrease urine output on maximal diuretic doses and ionotropes. On 6/8/03, the renal surgery recommended that the dobutamine be stopped in order to enhance renal perfusion and Lasix be increased to 80 mg per hour. He has beyond less invasive measures such as digoxin and ACE inhibitors, and he is now dobutamine dependent dobutamine between 1 and 2.5 mcg/kg/minute to maintain his cardiac output, currently loaded on amiodarone without any further events. He has a chronic osteomyelitis, currently in a six-week course of ceftazidime, vancomycin, Flagyl, and Diflucan for complicated osteomyelitis, end date is on 2/30/03. He has diabetes and was on oral hypoglycemic as an outpatient, however, now this renal function, he has been transitioned over to insulin with his standing doses of Lantus with a lispro sliding scale. The patient was started on TPN for quite severe malnutrition and has increasing albumin with increased appetite. Additionally, he is on maintenance doses of hydrocortisone and was seen by Psychiatry, who suggested starting low dose of Zyprexa in the evening, which has greatly improved his mood. He is planned to be evaluated by Plastic Surgery prior to discharge for final plans whether a flap or healing by secondary retention. The patient currently is stable and would be discharged with home dobutamine and frequent and careful follow up by his primary cardiologist Dr. Mongiovi.
|
What is the dosage of hydralazine
|
{
"answer_end": [
375
],
"answer_start": [
315
],
"text": [
"Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg"
]
}
|
A 63 year old male with a history of diabetes mellitus (DM), hypertension (HTN), obesity, and hyperlipidemia presented with chest pain two days ago and a four week history of chronic productive cough, rhinorrhea, and a sensation of nasal discharge down the back of the throat. Labs showed a normal chemical seven, CBC, and cardiac enzymes, and a CXR showed no acute process. The patient was started on ASA and a statin, Lipitor (Atorvastatin) 40 mg PO daily, ECASA 325 mg PO daily, Lantus (Insulin Glargine) 100 units SC daily, Humalog Insulin (Insulin Lispro) 12 units SC AC, Combivent (Ipratropium and Albuterol Sulfate) 2 spray NA daily, Loratadine 10 mg PO daily starting today (5/25), Metformin 1,000 mg PO BID, Prilosec (Omeprazole) 20 mg PO daily, and Azithromycin 250 mg PO daily x 3 doses. Potentially serious interactions were noted for Azithromycin and Atorvastatin Calcium, Simvastatin and Azithromycin, and Valsartan and Potassium Chloride, and the patient was instructed to follow up with his PCP for a possible outpatient stress imaging. In addition, the patient was prescribed Flonase Nasal Spray (Fluticasone Nasal Spray) 2 spray NA daily, Diovan (Valsartan) 160 mg PO daily, and provided with inhalers for wheezing PRN, with diet prophy: lovenox, nexium, 2 gram sodium, house/low chol/low sat. fat, and house/ADA 2100 cals/dy. An override was added on 8/15/06 by NAUMANN, CLAIR L., M.D. on order for Potassium Chloride Immed. Rel. PO (ref # 845941861). The patient was discharged with instructions to follow up with his PCP for a possible outpatient stress imaging and to take his medications as directed.
|
Has the patient ever had flonase nasal spray ( fluticasone nasal spray )
|
{
"answer_end": [
1156
],
"answer_start": [
1066
],
"text": [
"the patient was prescribed Flonase Nasal Spray (Fluticasone Nasal Spray) 2 spray NA daily,"
]
}
|
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage.
|
Has the patient had miconazole nitrate 2% powder in the past
|
{
"answer_end": [
2737
],
"answer_start": [
2657
],
"text": [
"trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas"
]
}
|
Vance Prunier, a 57 year old patient with diabetes mellitus, hypertension, hyperlipidemia, and known coronary artery disease, was admitted on 5/30/2001 with worsening exercise capacity. A cath today showed severe native TVD, patent LIMA to LAD, occluded SVG-OM, and radial graft to PDA 80% stenosis. PCI of radial graft lesion with Nir 2.5x15mm and S660 2.5x12mm stents resulting in 0% residual was done and Angioseal was applied to RFA. The patient was discharged on 6/17/2001 in a stable condition with medications EC ASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QPM, Cipro (Ciprofloxacin) 250 MG PO BID, Insulin NPH Human 30 UNITS SC QAM, Insulin Regular (Human) 18 UNITS SC QAM, Levoxyl (Levothyroxine Sodium) 75 MCG PO QD, Lisinopril 20 MG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], Pravachol (Pravastatin) 20 MG PO QHS, Amlodipine 5 MG PO QD, Imdur (Isosorbide Mononit.( SR )) 60 MG PO QD, Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID, Clopidogrel 75 MG PO QD, and 16 hours Integrilin and 30 days Plavix. The patient was instructed to call for any further chest pain, groin pain, swelling or bleeding and was to return to work after an appointment with the local physician. Follow up appointments with Dr. Minear in 1-2 weeks and Dr. Givens were scheduled. The patient was discharged to home.
|
has there been a prior lisinopril
|
{
"answer_end": [
767
],
"answer_start": [
744
],
"text": [
"Lisinopril 20 MG PO QD,"
]
}
|
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06.
|
Was the patient ever prescribed amiodarone
|
{
"answer_end": [
1330
],
"answer_start": [
1301
],
"text": [
"Amiodarone 200 mg p.o. daily,"
]
}
|
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.
|
Has the patient had multiple regular prescriptions
|
{
"answer_end": [
408
],
"answer_start": [
359
],
"text": [
"the morning with Regular 10 units in the morning,"
]
}
|
Justin Eans, a 56 year old patient with a history of DM, HTN, hypertryglyceridemia and depression, was admitted to the medical service on 11/4/2004 with 2-day h/o increasing abdominal girth, 1-day h/o shortness of breath, pleuritic CP and an increase in nocturia from 2x to 6x. He was given i.v. Lasix for presumed CHF, and his discharge medications included Tylenol (Acetaminophen) 500 mg PO Q6H PRN Pain, Headache, Atenolol 100 mg PO QD, Calcium Citrate 950 mg PO BID, Colace (Docusate Sodium) 100 mg PO BID, Gemfibrozil 600 mg PO BID, Hydrochlorothiazide 25 mg PO QD, NPH Insulin Human (Insulin NPH Human) 15 UNITS SC At 10 p.m. (bedtime), Lisinopril 40 mg PO QD, Niferex-150 150 mg PO BID, Simethicone 80 mg PO QID PRN Upset Stomach, Vitamin E (Tocopherol-DL-Alpha) 1,200 UNITS PO QD, Vitamin B Complex 1 TAB PO QD, Triamcinolone Acetonide 0.5% (Triamcinolone A...) TOPICAL TP QID, Levofloxacin 500 mg PO QD, Miconazole Nitrate 2% Powder Topical TP BID, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, Metformin XR (Metformin Extended Release) 2,000 mg PO QD, Insulin Regular Human Sliding Scale (subcutaneously) SC AC, and Potassium Chloride Immed. Rel. PO (ref #93677429) with the instruction to separate doses by 2 hours. Overrides were added on 0/28/04 and 3/3/04 by WILBY, BRYANT BRYON, M.D., WASHMUTH, SCOTTIE CLEO, M.D., and BEILER, TOMMY L. respectively. Additionally, the patient was instructed to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose and if on tube feeds, to cycle (hold 1 hr before to 2 hr after) and take 2 hours before or 2 hours after dairy products, with a 14-day course of Levofloxacin and to take ASA/NSAIDs for 6 - 8 weeks. He was discharged in satisfactory condition and was instructed to follow up with Endocrine and PCP re diabetes and lipid management, follow up with PCP for management of chronic medical problems, including GERD, gastric erosions, hypertension, and obstructive sleep apnea, and follow up with an outpatient psychiatrist regarding reinitiation of medications.
|
Is the patient currently or have they ever taken tylenol ( acetaminophen )
|
{
"answer_end": [
416
],
"answer_start": [
359
],
"text": [
"Tylenol (Acetaminophen) 500 mg PO Q6H PRN Pain, Headache,"
]
}
|
This 74-year-old gentleman with insulin-dependent diabetes mellitus, hypertension, and coronary artery disease presented with substernal chest pain on exertion and was admitted with T wave inversions in leads V3 and V4. Cardiac cath showed a 95% ostial LAD lesion, a 60% mid LAD lesion, an 80% distal LAD lesion, a 70% proximal D1 lesion, a 40% proximal circumflex lesion, a 90% ostial OM1 lesion, and a 100% proximal RCA lesion; he underwent CABG x3 with a Y graft, SVG1 connecting SVG2 to the LAD, SVG2 connecting the aorta to OM1, and SVG3 connecting to PDA. The patient is a Spanish-speaking only male who is neurologically intact, moving all extremities, getting in and out of bed, and very independent. He had a ventricular fibrillation arrest in the operating room due to an aprotinin reaction, necessitating open cardiac massage and requiring lidocaine and amiodarone use during the code. Medication on admission included Lopressor 50 mg p.o. t.i.d., Lisinopril 40 mg p.o. daily, Aspirin 325 mg p.o. daily, Hydrochlorothiazide/triamterene one tablet daily, Atorvastatin 80 mg p.o. daily, and Lantus 50 cc daily. The patient developed a deep sternal infection with E. coli and was started on Flagyl and Vancomycin for presumed aspiration pneumonia, Imipenem for ID's recommendation, and Nitrofurantoin and Ceftazidime for UTI. He is on Lopressor 25 mg q.6h, Amlodipine 5 mg b.i.d., Lasix 20 mg p.o. b.i.d., Aspirin, Atorvastatin, Lantus, NovoLog, and Diabetes Management. Imipenem and Vancomycin need to be continued for six weeks. He had a small area of erythema on his chest wound, but it is intact and he is being followed by Plastics. He had one brief episode of atrial fibrillation during a coughing spell, but it resolved and he is on antihypertensive medication. He was deemed fit for transfer back to the Step-Down Unit on postoperative day #18.
|
Is the patient currently or have they ever taken lisinopril
|
{
"answer_end": [
987
],
"answer_start": [
959
],
"text": [
"Lisinopril 40 mg p.o. daily,"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
Has the patient ever had colace
|
{
"answer_end": [
784
],
"answer_start": [
709
],
"text": [
"Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid,"
]
}
|
Ruben Elias Poupard is a 23-year-old morbidly obese male who presented with polyuria, polydypsia, nausea, and vomiting. He was diagnosed with diabetic ketoacidosis (DKA) with a blood sugar greater than 200, ketonuria, and pH less than 7.4. To correct hyperglycemia and acidosis, insulin was given along with 20mEQ of KCl and two liters of fluid. Blood sugar was erratic and was controlled with a regimen of Metformin 500mg PO BID, NPH 40u QAM and 15u regular insulin QAM, 10u regular insulin at noon if blood sugar was greater than 180, and NPH 40u QPM and 20u regular insulin QPM. The patient was instructed to take INSULIN NPH HUMAN 40 UNITS SC QAM Starting Today ( 6/1 ) and INSULIN REGULAR HUMAN 15 UNITS SC QAM with Instructions: can give with am dose of nph, METFORMIN 500 MG PO BID, and Pepcid AC QHS. He was also given a diabetic diet, education on finger sticks and insulin administration, and was instructed to have regular exercise and only 3 meals a day with limitation of snacks. Discharge instructions included continuing the diabetic insulin regimen and follow up appointments with the PCP and endocrine clinic.
|
has the patient used kcl in the past
|
{
"answer_end": [
345
],
"answer_start": [
279
],
"text": [
"insulin was given along with 20mEQ of KCl and two liters of fluid."
]
}
|
Mr. Lumadue is a 68-year-old man with significant cardiac history and vascular disease who came in with a chief complaint of hip pain after a mechanical fall. At that time, his hospital course was complicated by a non-Q wave MI, and Cardiology recommended medical management with Lopressor. An echocardiogram revealed an ejection fraction of 45%, and Dobutamine MIBI revealed a severe fixed perfusion defect in the inferoposterior and inferoseptal left ventricle with an ejection fraction of 26%. His medications included HCTZ 50 mg PO q.d., enteric-coated aspirin 325 mg PO q.d., Zestril 20 mg PO q.d., glyburide 5 mg PO q.d., multivitamins, and cough medicine PRN. Upon admission, his vital signs were afebrile, temperature 97.3, tachycardia, heart rate 106, blood pressure 162/77, oxygenation 94% on room air. X-rays of his left pelvis and femur revealed fracture of the left intertrochanter and subtrochanteric fracture with lesser trochanteric fracture intact by 3 cm, less than five degrees angulation. His femoral head was reduced. During his hospital course, the patient was started on a beta blocker, Ace inhibitor, and continued on an aspirin. He was aggressively diuresed with Lasix for diuresis and was treated with vancomycin, Flagyl, and levofloxacin for presumed aspiration pneumonia. He was continued on Lovenox 60 mg subcu. b.i.d. for prophylaxis against DVT post-hip surgery to continue for six months minimal followed by orthopedic surgery, and restarted on oral hypoglycemics prior to discharge in addition to sliding scale insulin. He was discharged on standing 20 mEq of K-Dur q.d., lisinopril 5 mg PO q.d., hold for systolic blood pressure less than 100, Lasix 100 mg PO q.d., Lovenox 60 mg subcu. b.i.d. x6 months, glipizide 2.5 mg PO q.d., sliding scale insulin, Nexium 20 mg PO q.d., Silvadene wet-to-dry dressing, DuoDerm to left lower leg wound and change q.3 days, and Lopressor 12.5 mg PO t.i.d., hold for systolic blood pressure less than 100. He was maintained on Nexium prophylaxis in the setting of his anticoagulation and on two liters of nasal cannula oxygen at the time of transfer to rehab. Upon discharge, he was instructed to follow up with his primary care physician, orthopedic surgery, cardiology, and pulmonary medicine within two weeks, with labs for a metabolic panel, magnesium, and calcium q.o.d. and physical therapy as needed, with a weightbearing status of non-weightbearing on the left lower extremity and weightbearing as tolerated on the right lower extremity.
|
Previous glyburide
|
{
"answer_end": [
627
],
"answer_start": [
604
],
"text": [
"glyburide 5 mg PO q.d.,"
]
}
|
The patient is a 55-year-old man with a history of smoking and a left sided hemisphere stroke, who underwent a right-sided femoral to popliteal bypass graft in February of 1986 for severe claudication. He was readmitted in March of 1988 for increase in pain in the calves and again in February of 1988 for graft stenosis and underwent angioplasty. He presented in July of 1989 with progressive pain and three months of rest pain in the right calf and claudication of the left calf. He also has a history of chest pain, esophageal reflux, anxiety disorder, chronic low back pain, peptic ulcer disease, herniated nucleus pulposus, and cholecystectomy. On admission, medications included Pepcid, 40 mg at h.s.; trazodone, 15 mg at h.s.; Carafate, one q.i.d.; nitroglycerin p.r.n. and Flexeril, 10 mg q eight hours p.r.n. back pain. Allergies include QUESTION OF PENICILLIN AND QUESTION OF DYE. He was taken to the Operating Room in March of 1990 for a right reverse saphenous bypass graft from the in situ vein graft to below the knee popliteal artery, and discharged with excellent palpable pulses.
|
has the patient had carafate
|
{
"answer_end": [
755
],
"answer_start": [
708
],
"text": [
"trazodone, 15 mg at h.s.; Carafate, one q.i.d.;"
]
}
|
Mr. Forde has recovered very well following his elective coronary artery bypass graft procedure and is hemodynamically stable with left lower extremity erythema and tenderness significantly improved 24 hours following initiation of Keflex course. White blood cell count was within normal limits and patient continued to remain afebrile. A course of Keflex was administered on postoperative day seven for sinus rhythm in the high 90s with blood pressure mildly hypertensive, additionally with frequent PVCs noted on telemetry. Mr. Notarnicola continued to remain afebrile and his knee pain has significantly improved. Additionally, of note, Mr. Hovenga's Toprol was increased to 150 mg p.o. daily with an extra 2 mg of magnesium. Mr. Neth is discharged to rehabilitation today having recovered well following his elective CABG procedure. Mr. Marcusen is discharged to rehabilitation today, postoperative day eight, hemodynamically stable, to continue a course of Keflex for left lower extremity erythema and additionally to continue one week of diuresis in the form of low dose Lasix for mild persistent postoperative pulmonary effusions. Mr. Brannigan has been instructed to shower and monitor incisions for signs of increasing infection such as fever, drainage, worsening pain or increase in redness. He is to follow up with his primary care physician for continued evaluation and management of hypertension, dyslipidemia, obesity, obstructive sleep apnea, and uncontrolled Type II diabetes mellitus. Additionally, the patient will follow up with his cardiologist for continued evaluation and management of blood pressure, heart rate, heart rhythm, lipid levels, and for possible future adjustment in medication. Mr. Connin will follow up with his cardiac surgeon, Dr. Quinn Dalio, in six to eight weeks. Additionally, he will follow up with his cardiologist, Dr. Octavio Wulffraat, in two to four weeks and with his primary care physician, Dr. Barrett Mittleman, in one to two weeks. The patient is discharged with medications including Tylenol 325 mg p.o. q.6h. p.r.n. pain for temperature greater than 101 degrees Fahrenheit, amlodipine 5 mg p.o. daily, atorvastatin 10 mg p.o. daily, captopril 6.25 mg p.o. t.i.d., Keflex 500 mg p.o. q.i.d. times total of seven days, last dose on 9/15/06, Colace 100 mg p.o. b.i.d. p.r.n. constipation, enteric-coated aspirin 325 mg p.o. daily, Lasix 40 mg p.o. daily x7 days, hydrochlorothiazide 12.5 mg p.o. daily, NovoLog 3 units subcu AC, Lantus 24 units subcu q. 10 p.m., hold if n.p.o., potassium slow release 20 mEq p.o. daily x7 days, Toprol-XL 150 mg p.o. daily, Niferex 150 mg p.o. b.i.d., oxycodone 5 to 10 mg p.o. q.4h. p.r.n. pain, Ambien 5 mg p.o. nightly p.r.n. insomnia, NovoLog 6 units subcu with breakfast, hold if n.p.o., NovoLog 4 units subcu with lunch, hold if n.p.o., NovoLog 4 units subcu with dinner, hold if n.p.o., NovoLog sliding scale subcu AC, blood sugar less than 125, give 0 units subcu, blood sugar 125 to 150, give 2 units subcu, blood sugar 151 to 200, give 3 units subcu, blood sugar 201 to 250, give 4 units subcu, blood sugar 251 to 300, give 6 units subcu, blood sugar 301 to 350, give 8 units subcu, if blood sugar 351 to 400, NovoLog sliding scale subcu q.h.s. Please recheck blood sugar less than 200, give 0 units subcu, if blood sugar 201 to 250, give 2 units subcu, blood sugar 251 to 300, give 3 units subcu, blood sugar 301 to 350, give 4 units subcu, blood sugar 351 to 400, give 10 units subcu, call physician if blood sugar greater than 400.
|
Previous keflex
|
{
"answer_end": [
359
],
"answer_start": [
299
],
"text": [
"patient continued to remain afebrile. A course of Keflex was"
]
}
|
A 57-year-old female with macromastia and abdominal skin laxity s/p massive weight loss 2/2 gastric bypass was admitted to plastic surgery on 5/8/07. On admission, the patient was prescribed 1. ACETAMINOPHEN 1000 MG PO Q6H, 2. LEVOTHYROXINE SODIUM 75 MCG PO QD, 3. QUINAPRIL 20 MG PO QAM, 4. RANITIDINE HCL 150 MG PO QD, 5. MULTIVITAMINS 1 CAPSULE PO QD, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, VITAMIN C ( ASCORBIC ACID ) 500 MG PO BID, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, KEFLEX ( CEPHALEXIN ) 500 MG PO QID, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, PEPCID ( FAMOTIDINE ) 20 MG PO BID, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain (ref #901341233), on order for DILAUDID PO 2-4 MG Q3H (ref #901341233), INSULIN REGULAR HUMAN, supplemental (sliding scale) insulin, If receiving standing regular insulin, please give at same, SYNTHROID ( LEVOTHYROXINE SODIUM ) 75 MCG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ), REGLAN ( METOCLOPRAMIDE HCL ) 10 MG IV Q6H PRN Nausea, ZOFRAN ( POST-OP N/V ) ( ONDANSETRON HCL ( POST-... ), on order for KCL IV (ref #964491549), POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM, SIMETHICONE 80 MG PO QID PRN Upset Stomach, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, TIGAN ( TRIMETHOBENZAMIDE HCL ) 200 MG PR Q6H PRN Nausea, ibuprfen. Do not drink/drive/operate machinery with pain medications., Take a stool softener to prevent constipation., 4. Continue your antibiotics as long as you have a drain in place., Sliding Scale (subcutaneously) SC AC+HS Medium Scale, If BS is 125-150, then give 0 units subcutaneously, 30 MILLILITERS PO DAILY PRN Constipation, 1 MG IV Q6H X 2 doses PRN Nausea, Number of Doses Required (approximate): 10, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain. The patient tolerated all procedures without difficulty and post-op period was uneventful, and at discharge, the patient was afebrile with stable vitals, taking po's/voiding q shift, ambulating independently and pain was well-managed with Tigan (Trimethobenzamide HCl) 200 mg PR Q6H PRN Nausea, Tigan (Trimethobenzamide HCl) 300 mg PO Q6H PRN Nausea, Simethicone 80 mg PO QID PRN Upset Stomach, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, 1 mg IV Q6H x 2 doses PRN Nausea, 30 Milliliters PO Daily PRN Constipation and TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, DULCOLAX (Bisacody
|
Has this patient ever been on reglan ( metoclopramide hcl )
|
{
"answer_end": [
1075
],
"answer_start": [
1021
],
"text": [
"REGLAN ( METOCLOPRAMIDE HCL ) 10 MG IV Q6H PRN Nausea,"
]
}
|
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.
|
What is her current dose of robitussin a-c
|
{
"answer_end": [
978
],
"answer_start": [
934
],
"text": [
"Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough,"
]
}
|
This 79 year old male was admitted to OCMC on 8/9/05 with a 1 cm left renal stone that had caused left hip and flank pain with nausea and vomiting. His cardiologist, Dr. Cannizzo, was consulted and Coumadin was held for the operation. It was originally planned to reverse INR with FFP, but the patient felt throat tightness after 5 minutes of FFP transfusion and FFP was stopped. He then underwent laser lithotripsy and stent placement on 8/0/50 and tolerated the procedure well. Post-op, he had frequent PVC but cardiac enzyme was negative. On POD2, he tolerated regular diet and was ready to be discharged home with Bactrim and low dose Coumadin. He was also noticed to have an enlarged prostate and needs to follow up with Dr. Domebo for further management. The discharge medications included CAPSAICIN 0.025 % TP BID (apply to legs), LASIX (FUROSEMIDE) 40 MG PO QD, MICRONASE (GLYBURIDE) 2.5 MG PO QD, L-THYROXINE (LEVOTHYROXINE SODIUM) 50 MCG PO QD, POTENTIALLY SERIOUS INTERACTION: DIGOXIN & LEVOTHYROXINE SODIUM (Reason for override: home), PYRIDIUM (PHENAZOPYRIDINE HCL) 100 MG PO TID (PRN Other:bladder/stent pain), PROBENECID 1,500 MG PO BID, COZAAR (LOSARTAN) 75 MG PO QD (HOLD IF: sbp <100), FLOMAX (TAMSULOSIN) 0.4 MG PO QD, NEXIUM (ESOMEPRAZOLE) 40 MG PO QD, BACTRIM DS (TRIMETHOPRIM/SULFAMETHOXAZOLE DOU...) 1 TAB PO Q24H, and Number of Doses Required (approximate): 5. He was advised to follow up with his PCP for INR check and Coumadin dose adjustment, take Coumadin at 3 mg for tonight and tomorrow night, resume his regular Coumadin dose schedule, call his Coumadin clinic on Monday for follow up regarding to blood check and Coumadin dosage adjustment, no lifting more than 10 lbs., no driving while on narcotics, and call Urology office 865-655-3733 for appointment and questions.
|
Has the patient ever had l-thyroxine ( levothyroxine sodium )
|
{
"answer_end": [
954
],
"answer_start": [
906
],
"text": [
"L-THYROXINE (LEVOTHYROXINE SODIUM) 50 MCG PO QD,"
]
}
|
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs.
|
What medication has the patient take for mildly agitated.
|
{
"answer_end": [
1141
],
"answer_start": [
1113
],
"text": [
"Zyprexa 2.5 mg p.o. q. h.s.,"
]
}
|
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06.
|
Has a patient had simvastatin
|
{
"answer_end": [
1642
],
"answer_start": [
1613
],
"text": [
"Simvastatin 80 mg p.o. daily,"
]
}
|
The patient is a 59 year old female with multiple cardiac risk factors, including obesity, diabetes mellitus, and cholesterol, who presents with exertional chest discomfort and early positive ETT. The patient underwent catheterization on 2/13/92 and athrectomy of her proximal LAD lesion which was complicated by the onset of severe chest discomfort and 100% occlusion of the LAD. The patient was subsequently brought to the cath lab on 10/9/92 and dilated to a 30% residual with balloon PTCA. The patient's post PTCA course was complicated by several episodes of transient chest discomfort which was relieved both by Mylanta and sublingual TNG. Glucotrol 7.5 mg p.o. q-day, Mevacor 10 mg p.o. q.d., Isoril 10 mg p.o. t.i.d., Propranolol 20 mg p.o. t.i.d., Nitroglycerin sublingual p.r.n., and Glucotrol with NPH subcu q.a.m. were administered, and the patient was treated with Mevacor for hypercholesterolemia. The patient was discharged with medications including Mevacor 10 mg p.o. q-day, Aspirin one p.o. q-day, Glucotrol 20 mg p.o. b.i.d., Isordil 40 mg p.o. t.i.d., Lopressor 200 mg p.o. b.i.d., and NPH 26 units subcutaneously each morning.
|
What medications if any has the patient tried for hypercholesterolemia in the past
|
{
"answer_end": [
911
],
"answer_start": [
873
],
"text": [
"with Mevacor for hypercholesterolemia."
]
}
|
The patient is a 54-year-old man with nonischemic dilated cardiomyopathy who presents with weight gain, weakness, and azotemia. He was admitted with decompensated heart failure and was treated with dobutamine, seretide, and diuretics with good effect, functioning on ACE inhibitor. Two weeks prior to presentation, Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg t.i.d., torsemide was being held, Coumadin 1 mg q.d., carvedilol 3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage, and glyburide were administered. On 2/19/03, Diuril was added to his regimen and his creatinine was noted to increase from 2.6 to 3.6 and diuretics were subsequently held. The patient was loaded on amiodarone, unfortunately still required low dose dobutamine to maintain his cardiac output and was transferred back to the floor and continued to have decrease urine output on maximal diuretic doses and ionotropes. On 6/8/03, the renal surgery recommended that the dobutamine be stopped in order to enhance renal perfusion and Lasix be increased to 80 mg per hour. He has beyond less invasive measures such as digoxin and ACE inhibitors, and he is now dobutamine dependent dobutamine between 1 and 2.5 mcg/kg/minute to maintain his cardiac output, currently loaded on amiodarone without any further events. He has a chronic osteomyelitis, currently in a six-week course of ceftazidime, vancomycin, Flagyl, and Diflucan for complicated osteomyelitis, end date is on 2/30/03. He has diabetes and was on oral hypoglycemic as an outpatient, however, now this renal function, he has been transitioned over to insulin with his standing doses of Lantus with a lispro sliding scale. The patient was started on TPN for quite severe malnutrition and has increasing albumin with increased appetite. Additionally, he is on maintenance doses of hydrocortisone and was seen by Psychiatry, who suggested starting low dose of Zyprexa in the evening, which has greatly improved his mood. He is planned to be evaluated by Plastic Surgery prior to discharge for final plans whether a flap or healing by secondary retention. The patient currently is stable and would be discharged with home dobutamine and frequent and careful follow up by his primary cardiologist Dr. Mongiovi.
|
Has this patient ever been treated with glucophage
|
{
"answer_end": [
494
],
"answer_start": [
441
],
"text": [
"3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage,"
]
}
|
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.
|
What medications has this patient tried for his systolic blood pressure
|
{
"answer_end": [
1374
],
"answer_start": [
1260
],
"text": [
"with Hydralazine p.o. added on hospital day #9 to lower his systolic blood pressure to the range of the 120s-130s."
]
}
|
This is a 70-year-old female with a history of coronary artery disease, hypertension, type II diabetes mellitus, and peripheral vascular disease who presented with increasing chest pain over the past month progressing to pain at rest. On admission, the patient had a blood pressure of 230/90 and was treated with IV Lopressor and Diltiazem drip at 10 mg/hr. The patient underwent cardiac catheterization on 2/25/99, revealing stent restenosis of left circumflex artery, a 60 percent left anterior descending artery stenosis, a 70 percent diagonal ostial stenosis, a 40 percent ostial right coronary artery stenosis, and 95 percent ostial posterior descending artery stenosis. The patient was admitted for rule out myocardial infarction and subsequently underwent a coronary artery bypass graft times three with a left internal mammary artery to the left anterior descending artery and saphenous vein graft to obtuse marginal and saphenous vein graft to posterior descending artery. Postoperatively, the patient was treated with IV Lopressor and Diltiazem drip at 10 mg/hr. for a period of atrial fibrillation with a rapid ventricular response and rates in the 150s. The patient was started on MEDICATIONS including Aspirin 325 mg q.d., Atenolol 125 mg p.o. b.i.d., Captopril 100 mg p.o. t.i.d., Colace, Axid 150 mg p.o. b.i.d., Amlodipine 10 mg p.o. q.d., Imdur 120 mg p.o. b.i.d., and insulin NPH 22 units q.a.m. and regular 10 units q.a.m., and anticoagulation with Coumadin. The patient subsequently converted spontaneously to normal sinus rhythm and was started back on Amlodipine for further blood pressure control and was started on Lopressor and Captopril and gradually increased to preoperative doses. The patient continued to experience brief episodes of atrial fibrillation with spontaneous conversion to normal sinus rhythm. At the time of discharge, the patient was advised to follow-up in six weeks with cardiac surgeon, Dr. Standrew, with primary care physician, Dr. Birdsong, in one to two weeks, and with cardiologist, Dr. Shelko, in one to two weeks, with Discharge Medications: Atenolol 125 mg p.o. b.i.d., Captopril 100 mg p.o. t.i.d., Colace 100 mg p.o. t.i.d., Lasix 40 mg p.o. q.d., insulin 22 units NPH subcu q.a.m. and 10 units regular subcu q.a.m., CZI regular insulin sliding scale, Percocet 1 to 2 tablets p.o. q3 - 4h p.r.n. pain, Zantac 150 mg p.o. b.i.d., Coumadin dosed to INR of 2 to 2.5, and Amlodipine 5 mg p.o. q.d.
|
Has the pt. ever been on zantac before
|
{
"answer_end": [
2385
],
"answer_start": [
2309
],
"text": [
"Percocet 1 to 2 tablets p.o. q3 - 4h p.r.n. pain, Zantac 150 mg p.o. b.i.d.,"
]
}
|
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage.
|
Has the patient ever had packed red blood cells
|
{
"answer_end": [
1150
],
"answer_start": [
1058
],
"text": [
"She responded well initially to three units of packed red blood cells over 7/28/2005 and 09."
]
}
|
Stettler, Hal 223-66-98-9, an 81 y.o. woman, was admitted to the hospital on 1/15/2004 with pneumonia and discharged on 6/18/2004. Mrs. Marnett presented with chest pain, difficulty speaking, nausea, and lightheadedness and had URI symptoms two weeks prior. On arrival to the floor, a raised, painful area was noted on her L forearm. PMedHx includes H/o agina, Echo (1/29) with EF 55%, abnormal septal motion, mild AR, no MR, mod TR, Holter 0/2 with multiform VE (bigem, cooup), SVE's 1st degree A-V block, D.M. AGA1c 6.1 (6/17), subacute thalamic stroke noted on CT 1/29, Afib - on COUMADIN, Mitral stenosis - MVR St Jude (4/27), CHF, Restrictive lung disease- 5/23 PFTs FVC 1.33, FEV1 0.98, Sigmoid colostomy, Ventral hernia repair, Bladder calcifications on CT urogram (1/29), HTN, RA, and Recent eye hemorrhage. VS: T 98.9 P 103, BP 160/74, RR 20, OxySat 97% 2L NC, FSG 172. On order for COUMADIN PO (ref # 17623917), the patient was prescribed AMIODARONE 200 MG PO QD, GLIPIZIDE 2.5 MG PO QD, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, SARNA TOPICAL TP QD Instructions: to lower extremities, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QOD, HYDROCORTISONE 1% -TOPICAL CREAM TP BID Instructions: to R elbow eczema, LEVOFLOXACIN 250 MG PO QD Starting IN AM (3/0), NIZORAL 2% SHAMPOO (KETOCONAZOLE 2% SHAMPOO) TOPICAL TP tiweek, GUAIFENESIN 10 MILLILITERS PO Q6H Starting Today (2/12) PRN Other:cough, SYNALAR 0.025% CREAM (FLUOCINOLONE 0.025% CREAM) TOPICAL TP BID Instructions: `, PLAQUENIL (HYDROXYCHLOROQUINE) 200 MG PO BID, NORVASC (AMLODIPINE) 10 MG PO QD, and was instructed to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose. POTENTIALLY SERIOUS INTERACTIONS between AMIODARONE HCL & WARFARIN, LEVOFLOXACIN & WARFARIN, and LEVOFLOXACIN & AMIODARONE HCL were Override Notices added on 2/19/04, and an Alert was overridden for POSSIBLE ALLERGY (OR SENSITIVITY) to SULFA. The patient was discharged on 1/29/04 at 05:00 PM contingent upon attending evaluation, and the code status was Full Code with the disposition home with services. The patient was to finish 6 more days of Levo (total 10) and was monitored as an outpatient while on levofloxacin. Her INR was 3 after 2 days of levofloxacin and will be checked again by VNA 3 days, and if fever, SOB, increasing left arm pain, or other symptoms, the patient was to call the doctor, weigh herself daily, and not restart HTN meds until Dr. Schoville tells her to.
|
What is the current dose of the patient's plaquenil ( hydroxychloroquine )
|
{
"answer_end": [
1525
],
"answer_start": [
1480
],
"text": [
"PLAQUENIL (HYDROXYCHLOROQUINE) 200 MG PO BID,"
]
}
|
A 58 year old female smoker with a history of Coronary Artery Disease (CAD), Cirrhosis, Diabetes Mellitus Type II (DMII), Hypertension (HTN), and Hyperlipidemia was admitted to the CCU after an elective cardiac catheterization following an abnormal stress test. The cath showed impaired flow in the inferior and posterolateral zones due to obstructive degenerative disease in the SVGs to the RCA and LCF-OM, and a stent was placed in the RCA graft though there was extensive calcification and difficulty obtaining full stent expansion. After the stent deployment there was poor reflow accompanied by mild chest pain and EKG changes, without hemodynamic embarrassment. The patient experienced jaw and chest pain post-procedure which she described as different from previous episodes of angina. The pump-function was preserved, BP low-normal, and rhythm was NSR on telemetry. For pulmonary issues, the patient had a chronic cough due to post nasal drip which was taken off of her antihistamine on admission and CXR was normal with no acute changes. There were no renal issues during the hospital course and the patient was on Lantus, Novolog SS, and FS Glu monitored while in the hospital. Heme-wise, the patient had a cath and subsequent oozing from the site in the groin and was discharged on home meds including Plavix and ASA. Medications prescribed include ENTERIC COATED ASA 325 MG PO DAILY, TESSALON PERLES ( BENZONATATE ) 100 MG PO TID, PLAVIX ( CLOPIDOGREL ) 75 MG PO DAILY, CODEINE PHOSPHATE 15 MG PO Q3H PRN Pain, DEXTROMETHORPHAN HBR 10 MG PO Q6H PRN Other:cough, ZETIA ( EZETIMIBE ) 10 MG PO DAILY, LANTUS ( INSULIN GLARGINE ) 20 UNITS SC BEDTIME, POTASSIUM CHLORIDE IMMED. REL. ( KCL IMMEDIATE... ) 1.Only KCL Immediate Release products may be used for KCL, 4.As per SMH Potassium Chloride Policy: each 20 mEq dose, on order for DIOVAN PO ( ref # 032637277 ), VALSARTAN Reason for override: aware, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MAGNESIUM GLUCONATE Sliding Scale PO ( orally ) DAILY: -> Mg-scales cannot be used and magnesium doses must be, If Mg level is less than 1 , then give 3 gm Mg Gluconate, NITROGLYCERIN 1/150 ( 0.4 MG ) 1 TAB SL q5min x 3, OXYCODONE 5-10 MG PO Q6H PRN Pain, PINDOLOL 5 MG PO BID HOLD IF: sbp<90 , HR<50, ZOCOR ( SIMVASTATIN ) 80 MG PO BEDTIME, DIOVAN ( VALSARTAN ) 160 MG PO DAILY, Lantus 40u qd Estradiol 0.05, Diltiazem 180 mg qd HCTZ 25 mg qd, Zetia 10mg qd, Plavix 75 mg qd, Zocor 80 mg qd, ASA 325 mg qd, Famotidine 20 mg BID, Lovenox 40 sc qd, nicotine patch MgSO4 qd, Novolog SS Pt as outpt and heparin and Integrelin have been discontinued, insulin, and was stable post cath, with anticoagulation stopped. The patient was prescribed ENTERIC COATED ASA 325 MG PO DAILY, TESSALON PERLES ( BENZONATATE ) 100 MG PO TID, PLAVIX ( CLOPIDOGREL ) 75 MG PO DAILY, CODEINE PHOSPHATE 15 MG PO Q3H PRN Pain, DEXTROMETHORPHAN HBR 10 MG PO Q6H PRN Other:cough, ZETIA ( EZETIMIBE ) 10 MG PO DAILY, LANTUS ( INSULIN GLARGINE ) 20 UNITS SC BEDTIME, POTASSIUM CHLORIDE IMMED. REL. ( KCL IMMEDIATE... ), 1.Only KCL Immediate Release products may be used for KCL, 4.As per SMH Potassium Chloride Policy: each 20 mE
|
How much codeine phosphate does the patient take per day
|
{
"answer_end": [
1522
],
"answer_start": [
1482
],
"text": [
"CODEINE PHOSPHATE 15 MG PO Q3H PRN Pain,"
]
}
|
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.
|
Has patient ever been prescribed beta-blocker
|
{
"answer_end": [
341
],
"answer_start": [
259
],
"text": [
"He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5,"
]
}
|
A 83 year old female with hereditary angioedema was admitted to the hospital with abdominal pain which was not relieved by Stanazolol, and she had diarrhea, nausea/vomiting, sweats, and decreased PO intake. She was given 6 units FFP with premedication of IV Benadryl on the first night of her hospitalization, Stanazolol 4 mg q4h overnight, which was changed to bid on second hospital day, Zantac, and Lovenox. The patient was maintained on Acetylsalicylic Acid 81 mg PO qd, Vit C 500 mg PO bid, Atenolol 75 mg PO qd, hold if sbp <100 or hr <60, Digoxin 0.125 mg PO qod (Sun, Tues, Thurs), Potentially serious interaction: Digoxin & Levothyroxine Sodium, Vit E 400 units PO qd, Pepcid 20 mg PO qd, Colace 100 mg PO bid PRN constipation, Senna Tablets 2 tab PO bid PRN constipation, Lasix 20 mg PO qd, Keflex 500 mg PO qid x 28 doses, and on order for Synthroid PO (ref. #66804792), Lasix PO (ref. #91042032), and Keflex PO (ref. #63524947). She was also continued on her home dose of Synthroid, Rhinocort (Budesonide Nasal Inhaler) 2 spray na bid, and Allegra (Fexofenadine HCl) 60 mg PO bid. She was discharged with instructions to follow up with allergy and to call her doctor if she develops fevers, worsening of her abdominal pain, or other concerning symptoms. Follow up appointments were made with Dr. Morrell and Dr. Guadagnolo or Dr. Yoes for 1-2 weeks.
|
Has the patient had multiple digoxin prescriptions
|
{
"answer_end": [
589
],
"answer_start": [
546
],
"text": [
"Digoxin 0.125 mg PO qod (Sun, Tues, Thurs),"
]
}
|
Ms. Hora is a 45 year old woman with hypertensive disease, diabetes, obesity, sleep apnea and peptic ulcer disease who presented with sustained chest pain and shortness of breath. She underwent an exercise tolerance test with MIBI which showed a borderline to minimal anterior reversible defect. The patient was admitted and ruled out for a myocardial infarction with serial CPK and serial troponin, both of which showed 0.0. She was managed by the addition of a gastrointestinal regimen of Prilosec and Cisapride, and the addition of isordil 10mg po tid in the place of Axid. The discharge medications included Proventil 2 puffs inhaler q.i.d., enteric coated aspirin 325 mg p.o. q.day, NPH 40 units q.AM and 55 units subcu q.PM., Lisinopril 20 mg p.o. q.day, Maxide 1 tablet p.o. q.day, nitroglycerin 1/150 1 tablet sublingual q.5 minutes times three p.r.n. chest pain, Prilosec 20 mg p.o. q.day, Azmacort 4 puffs inhaler b.i.d., Cardizem CD 300 mg p.o. q.day, Cisapride 10 mg p.o. q.i.d., and isordil 10 mg po tid.
|
Why has the patient been prescribed nitroglycerin 1/150
|
{
"answer_end": [
898
],
"answer_start": [
789
],
"text": [
"nitroglycerin 1/150 1 tablet sublingual q.5 minutes times three p.r.n. chest pain, Prilosec 20 mg p.o. q.day,"
]
}
|
Marcelo Walts was admitted to the medical service for a CHF exacerbation and was given ECASA (Aspirin Enteric Coated) 325 mg PO QD, Captopril 12.5 mg PO TID with a potential serious interaction with Potassium Chloride, Lasix (Furosemide) 40 mg PO TID, Levoxyl (Levothyroxine Sodium) 100 mcg PO QD, Nitroglycerin 1/150 (0.4 mg) 1 tab SL Q5 min x 3 PRN Chest Pain HOLD IF: SBP<[ ], Zocor (Simvastatin) 20 mg PO QHS with a potential serious interaction with Niacin, Vit. B-3, Plavix (Clopidogrel) 75 mg PO QD, Atenolol 25 mg PO QD, Nitropatch (Nitroglycerin Patch) 0.2 mg/hr TP QHS, Glyburide 5 mg PO BID, Isordil (Isosorbide Dinitrate) 10 mg PO BID, and a diet of House/Low Chol/Low Sat. Fat and 4 gram Sodium. Activity was limited to Walking as tolerated, and the patient was also given instructions to give ECASA on an empty stomach, and to avoid grapefruit with Zocor unless instructed otherwise. Upon discharge, the patient was given a Full Code status and was sent Home with a follow up appointment with Sandler on 11/28/02. The patient also underwent cardiac catheterization and stent placement of RCA with the medications Heparin, ASA, Plavix, Metoprolol, nitrates, ACE-I, statin, lasix, and nebs for wheezing, and was monitored for lytes. Upon discharge, the patient was stable and advised to follow up with Dr. Lidstone and Dr. Darlin for post-cath management and overall management of CHF and flash pulmonary edema.
|
What is the current dose of zocor ( simvastatin )
|
{
"answer_end": [
412
],
"answer_start": [
380
],
"text": [
"Zocor (Simvastatin) 20 mg PO QHS"
]
}
|
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
|
What was the dosage prescribed of omeprazole
|
{
"answer_end": [
1259
],
"answer_start": [
1233
],
"text": [
"OMEPRAZOLE 20 MG PO DAILY,"
]
}
|
Dewey Wittie, a 54 year old Hispanic female with morbid obesity, hypertension, non-insulin dependent diabetes mellitus, and sleep apnea on CPAP, was admitted to the MED service on 8/14/2006 for atypical chest pain. An ETT was performed in the ED with an EF of 55%, not in failure, and htn was controlled with BB and ACEI. She presented with one week history of intermittent left arm pain while washing dishes, lasting 15 minutes, sometimes radiating to her left chest, positional, not associated with shortness of breath, nausea, or vomiting. She responded to sublingual nitroglycerin (within 5-10 minutes) and her first set of cardiac enzymes is negative. She received aspirin and heparin gtt was started. Her home medications included Atenolol 50AM/25PM, Avadia 8, Fluoxetine 20, Metformin 1gm BID, Glyburide 10BID, Lisinopril 20, CaCO3 1200QD, and Amitriptyline 50QHS. She completed a ROMI and exercise tolerance test, which she walked for 2 minutes and 33 seconds at 75% maximum predicted heart rate, and stopped due to fatigue with no EKG changes. She was discharged stable with instructions to follow up with an A1C and lipid profile, and to pursue weight reduction. She was advised to resume regular exercise and make a follow up appointment with their primary care provider. The discharge medications included AMITRIPTYLINE HCL 50 MG PO BEDTIME, ENTERIC COATED ASPIRIN (ASPIRIN ENTERIC COATED) 81 MG PO DAILY, ATENOLOL 50 MG QAM; 25 MG QPM PO 50 MG QAM 25 MG QPM, CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY, FLUOXETINE HCL 20 MG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: o, METFORMIN 1,000 MG PO BID, AVADIA 8 UNIT DAILY, and GLYBURIDE 10 MG PO BID. The patient was warned about a potentially serious interaction between lisinopril and potassium chloride. The patient's diet was house/low chol/low sat. fat and ADA 1800 cals/dy, with 4 gram sodium.
|
Has this patient ever been on amitriptyline hcl
|
{
"answer_end": [
1353
],
"answer_start": [
1318
],
"text": [
"AMITRIPTYLINE HCL 50 MG PO BEDTIME,"
]
}
|
Mr. Royce Meidlinger is a 78-year-old male who was admitted on 11/12/05 with ADMISSION MEDICATIONS including Atenolol 25 mg daily, allopurinol 300 mg daily, and Flomax 0.8 mg daily. Cardiovascularly, he was on aspirin and had a pacemaker for sick sinus and was saturating well on 2 liters of oxygen delivered by Dobbhoff. Respiratorily, white count at preop baseline was afebrile completing 21 day course of linezolid for EC bacteremia and chest x-ray improved after adding low-dose Lasix. Renally, there was a postoperative increase in creatinine requiring dopamine 2 mcg, continued high chest tube output and an official echo report showed moderate TR, with no changes from prior echos. Hematology was treated with aspirin and anticoagulation and he had left upper extremity DVT as well, was started on argatroban, PTT to be therapeutic, with argatroban dose increased from 0.1 to 0.2, bridging to Coumadin, and argatroban dose reduced to maintain PTT of 50. He had profuse GI bleeding requiring 3 units of packed red blood cells, 2 units packed red blood cells with improvement in hematocrit, NG-tube aspiration with melena, and was HIT positive with worsening clinical syndrome. Foley was put in place with Lasix for reduced urine output and left hand demarcated with argatroban dose increased from 0.1 to 0.2, bridging to Coumadin, restarting Coumadin, postop day #51, patient went to OR with plastics for toe finger amputations/left hand debridement, holding tube feeds, was on triple antibiotic therapy for sputum/blood culture, and rehabilitation when restarting Coumadin. Postop day #54
|
What medications if any has the patient tried for anticoagulation in the past
|
{
"answer_end": [
744
],
"answer_start": [
689
],
"text": [
"Hematology was treated with aspirin and anticoagulation"
]
}
|
Mr. Esbenshade is a 70-year-old Caucasian male with CAD, stented five years ago, known as calcific aortic stenosis with progression of exertional dyspnea. He was admitted to CSS and stabilized for surgery on 9/13/06, which included AVR with a 25 CE magna valve, CABG x2 with LIMA to LAD and SVG1 to PDA, pulmonary vein isolation, and left atrial appendage resection, with no complications. He is currently on 5 liters of O2 and some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis, on Osmolite tube feeds at 20 mL an hour, with prophylactic antibiotics for chest tubes, medications IV, Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily, atorvastatin 20 mg daily, Neurontin 100 mg t.i.d., metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d. Cardiac meds include Aspirin, Lopressor, and Coumadin. He has been followed by psych for postoperative confusion/possible suicidal ideation, with Celexa ordered per psych. He is also on Acetaminophen 325-650 mg q. 4h. p.r.n. pain or temperature greater than 101, DuoNeb q. 6h. p.r.n. wheezing, enteric-coated aspirin 81 mg daily, Dulcolax 10 mg PR daily p.r.n. constipation, Celexa 10 mg daily, Colace 100 mg t.i.d., Nexium 20 mg daily, K-Dur 10 mEq daily for five days, Toprol-XL 200 mg b.i.d., miconazole nitrate powder topical b.i.d., Niferex 150 mg b.i.d., simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily, INR, and Boudreaux's Butt Paste topical apply to effected areas. He has been running a bit fast in Afib and is on Coumadin and aspirin for atrial fibrillation, and is awaiting a rehabilitation bed. Cipro x3 days has been started due to a UA from 10/5/06 with probable enterogram-negative rods. His mood has improved and beta-blocker has been titrated. He has been advised to make all follow-up appointments, local wound care, wash wounds daily with soap and water, shower patient daily, keep legs elevated while sitting/in bed, watch all wounds for signs of infection, redness, swelling, fever, pain, discharge, and to call PCP/cardiologist or Anle Health Cardiac Surgery Service at 282-008-4347 with any questions.
|
Has a patient had lopressor.
|
{
"answer_end": [
831
],
"answer_start": [
777
],
"text": [
"Cardiac meds include Aspirin, Lopressor, and Coumadin."
]
}
|
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 patient ever been prescribed lisinopril
|
{
"answer_end": [
474
],
"answer_start": [
412
],
"text": [
"Preoperative medications included Lisinopril 20 mg p.o. daily,"
]
}
|
Mr. Gramby is a 43-year-old man with morbid obesity, type II diabetes, hypertension, hyperlipidemia, chronic renal insufficiency, and severe peripheral arterial disease status post femoral popliteal bypass in July which was complicated by repeated return of cellulitis x 2 who was admitted with cellulitis and volume overload. He was initially treated with courses of intravenous nafcillin and vancomycin for four weeks, having been seen by Vascular Surgery five days prior to admission and had been started on dicloxacillin for a third episode of cellulitis. He had also presented with fluid overload and spironolactone was added to his diuretic regimen. The patient was prescribed Atenolol 100 mg q.d., spironolactone, torsemide 160 mg b.i.d., Hyzaar 50/12.5 q. day, lisinopril 60 mg q. day, Neurontin 1200 mg t.i.d., Norvasc 10 mg q.a.m. and 5 mg q.p.m., Coumadin 8 mg, aspirin, Humalog sliding scale, Percocet, Pletal 100 mg b.i.d., Procrit, Zantac, nitroglycerin p.r.n., and NPH 80 q.a.m. and q.p.m. His torsemide was changed to IV and metolazone was added on the first day of admission and his electrolytes were replaced as needed. He was hypertensive on arrival, which was treated with Hydralazine initially and transitioned to his p.o. home medicines, with Hydralazine p.o. added on hospital day #9 to lower his systolic blood pressure to the range of the 120s-130s. His Coumadin was restarted when his INR was 2.2 and he his now in the therapeutic range and will need to be followed. The patient is on NPH and Humalog, with NPH doses increased to 90 units in the morning and 85 units at night, and the goal for this patient is below 150 particularly given the need for wound healing. Additional antibiotic coverage was added specifically of fluoroquinolone for anti-psuedomonal coverage for his diabetic foot ulcers, with surgical debridement done in the operating room with drainage of pus, but the metal showed could not be located even with fluoroscopy. The patient will complete a 14-day course of levofloxacin and clindamycin for these foot ulcers, and will be discharged home with visiting nursing care for b.i.d. wet-to-dry dressing changes. He will follow up with Jerold Cristopher Blazon, M.D. in one to two weeks, go home with visiting nurse care, and will need to see his nephrologist, vascular surgeons, primary care provider, and Bariatric Surgery following discharge.
|
Has this patient ever been treated with norvasc
|
{
"answer_end": [
872
],
"answer_start": [
820
],
"text": [
"Norvasc 10 mg q.a.m. and 5 mg q.p.m., Coumadin 8 mg,"
]
}
|
This is a 69 year-old woman with a history of congestive heart failure and hypertension who presented with a productive cough which was worsening over the past 3-4 days and fever to 101 with chills and shakes and increasing shortness of breath. She had a white blood cell count of 9.3 with 54% polys and 9.6 % eosinophils, a glucose of 377, and a chest x-ray without evidence of congestive heart failure or infiltrate. She was treated in the emergency room with Albuterol nebulizer and plans were to discharge her to home, however, her saturations dropped to 89% on room air with exercise in the emergency room and was admitted for further observation. She was started on intravenous Cefuroxime, and initially improved with decrease in cough and shortness of breath; however, the patient continued to desat with exercise. A repeat chest x-ray was performed which showed no change when compared to the admission film. Her sputum culture grew out Pen-sensitive E-coli and she was continued on her intravenous and then PO antibiotics. She continued to desat with exercise, however, and her cough persisted although she remained afebrile with a slightly elevated white count and moderate peripheral eosinophilia. Her chest exam remained rancorous and the reason for this remained unclear. Given the finding of E-coli in the sputum sample, in addition to the elevated eosinophilia and lack of finding on chest x-ray despite significant findings on chest exam, the possibility of a worm or parasitic disease was raised. She had a Persantine MIBI in March of 1996, on which she had no fixed or reversible defects, and was on nitroglycerin for stable angina - "chest heaviness" after climbing one flight of stairs, relieved by rest and one sublingual nitroglycerin. Her medications on admission included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m. and 5 units q p.m., Verapamil SR 120 mg PO b.i.d., Enteric coated aspirin 325 mg q day, KCL 10 mEq PO q day, Premarin 0.625 mg PO q day, Zestril 20 mg b.i.d., Atenolol, recently discontinued, Tofranil 75 mg PO q HS, Albuterol inhaler two puffs inhaled q.i.d., and Potassium slow release 10 mEq PO q day. She was discharged to home with Albuterol inhaler and instructions to follow up with her primary physician in clinic for further evaluation including PFTs and possible chest CT if symptoms did not abate, and to finish a full ten day course of antibiotics for presumed bronchitis. At the time of discharge the patient's saturation was 92 to 93% on room air and dropping slightly to 90 to 91% with exercise, however she was tolerating this well and was getting relief from her Albuterol inhaler.
|
What medications if any has the patient tried for shortness of breath in the past
|
{
"answer_end": [
718
],
"answer_start": [
653
],
"text": [
"She was started on intravenous Cefuroxime, and initially improved"
]
}
|
Patient Omar J. Coolbaugh, a 71-year-old female post cardiac transplant with allograft coronary artery disease, bilateral carotid disease, TIA, diabetes, and obesity, was admitted on 11/8/2007 and discharged on 4/14/2007 with s/p angioplasty and stenting. The medications on admission included Mycophenolate Mofetil 1000 mg PO BID, Oxybutynin Chloride XL 10 mg PO QD, Insulin Glargine 20 units SC QAM, Furosemide PO QD, Clopidogrel 75 mg PO QD, Pravastatin 40 mg PO QHS, Prednisone 5 mg PO QD, Cyclosporine (Sandimmune) 75 mg PO BID, Metoprolol Succinate Extended Release 50 mg PO QD, and Fenofibrate (Tricor) 48 mg PO QD. Elective cardiac catheterization was performed, revealing double vessel disease and successful PTCA/Stenting of LAD was done using XB3.5 guide, BMW, with no residual stenosis. The patient was advised to take Enteric Coated ASA 325 mg PO Daily, Plavix (Clopidogrel) 75 mg PO Daily, Cyclosporine (Sandimmune) 75 mg PO BID, Tricor (Fenofibrate (Tricor)) 48 mg PO Daily, Lasix (Furosemide) 40 mg PO Daily, Insulin Glargine 20 units SC Daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO Daily, CellCept (Mycophenolate Mofetil) 1,000 mg PO BID, Ditropan XL (Oxybutynin Chloride XL) 10 mg PO Daily, Pravachol (Pravastatin) 40 mg PO Bedtime, Prednisolone Sodium Phosphate 5mg/5ml 5 mg PO Daily, and vitamins, with ASA 325 and Plavix for life and other medications at usual doses, plus TNG 0.4 mg (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 doses PRN Chest Pain. The importance of both aspirin and taking medications consistently was stressed and the patient understands, with diet house/low chol/low sat. fat and activity light activity with no heavy lifting or driving x 2 days, ok to shower, no swimming or bathing x 5 days and lift restrictions of not lifting greater then 10-15 pounds. Follow up appointments were scheduled for Heart Failure Clinic 2-4 weeks and patient was discharged in stable condition and advised to drink plenty of fluids over the next several days, and to call with any questions or concerns.
|
Has the patient had previous vitamins.
|
{
"answer_end": [
1351
],
"answer_start": [
1329
],
"text": [
"vitamins, with ASA 325"
]
}
|
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.
|
How much lipitor ( atorvastatin ) does the patient take per day
|
{
"answer_end": [
673
],
"answer_start": [
638
],
"text": [
"LIPITOR (Atorvastatin) 80 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.
|
Previous metformin
|
{
"answer_end": [
695
],
"answer_start": [
619
],
"text": [
"Metformin added to his home diabetic regimen upon discharge were prescribed."
]
}
|
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
|
Was the patient ever given ppi for barrett's
|
{
"answer_end": [
2076
],
"answer_start": [
2059
],
"text": [
"Barrett's on PPI,"
]
}
|
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.
|
Has a patient had ativan
|
{
"answer_end": [
85
],
"answer_start": [
21
],
"text": [
"taking Ativan of 3-4 mg q.d. for anxiety for the past two months"
]
}
|
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone
|
Was the patient ever prescribed oxycodone
|
{
"answer_end": [
569
],
"answer_start": [
517
],
"text": [
"Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain,"
]
}
|
This 63 year-old male with a history of peripheral vascular disease, hypertension, non-insulin dependent diabetes mellitus, coronary artery disease, aortic stenosis, and status post bilateral lower extremity bypass grafts presented to the hospital with increasing left lower extremity pain. At which time tPA infusion was commenced and an occlusion of the left lower extremity vein graft was found in the area of the mid-thigh with no passage of contrast and minimal reconstitution of collaterals to his foot. He was managed medically for a few days and underwent catheterization which revealed a right dominant system, a discreet 40% lesion in the proximal left main, a discreet 30% lesion in the proximal left anterior descending artery, 100% lesion in the first marginal branch of the left circumflex artery, as well as 100% lesion in the second marginal branch of the left circumflex artery. He was taken to the operating room on 0/27/02 for an aortic valve replacement with a #23 Carpentier-Edwards pericardial valve and mitral valvuloplasty with an Alfieri suture repair, as well as coronary artery bypass graft times three with left internal mammary artery to the left anterior descending artery, left radial to obtuse marginal one, and left radial to posterior descending artery. During his hospital course he was on MEDICATIONS: Glipizide 5 mg b.i.d., Hydrochlorothiazide 50 mg q.d., Lisinopril 20 mg q.d., Simvastatin 20 mg q.d., Amlodipine 5 mg q.d., Imdur 30 mg q.d., and Toprol 100 mg q.d. and enteric coated aspirin, and he remained on his aspirin and Lopressor, as well as Coumadin. He was placed on the Portland protocol and remained on a full ten-day course of Flagyl and Cefotaxime for his preoperative pneumonia. On his pre-discharge examination he was discharged to rehabilitation with DISCHARGE MEDICATIONS: Coumadin 4 mg p.o. q.hs to maintain INR between 2 and 3, aspirin, Diltiazem 30 mg t.i.d., Simvastatin 20 mg q.d., Colace 100 mg t.i.d., Nexium 20 mg q.d., Niferex-150 b.i.d., Glipizide 5 mg b.i.d., Lasix 40 mg b.i.d., and Lopressor 50 mg b.i.d. with CZI sliding scale.
|
Has the patient ever been on coumadin
|
{
"answer_end": [
1576
],
"answer_start": [
1550
],
"text": [
"his aspirin and Lopressor,"
]
}
|
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 tried kcl slow release
|
{
"answer_end": [
336
],
"answer_start": [
296
],
"text": [
"KCL SLOW RELEASE PO ( ref # 761602437 ),"
]
}
|
The patient is a 59 year-old right-handed woman admitted for suspected acute stroke with a PMH of hypertension, hypercholesterolemia, prior TIA vs. stroke, recurrent left Bell's palsy, obesity, allergic rhinitis, history of TIA vs. stroke, obstructive sleep apnea, and chronic renal insufficiency. She was put on Acetylsalicylic Acid 325 mg PO QD, Atenolol 50 mg PO QD Starting in AM (2/11), Atorvastatin 40 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Amlodipine 10 mg PO QD Food/Drug Interaction Instruction, and PRN albuterol and loratadine. She was also placed on aspirin 325 mg qd for stroke and heart prophylaxis and should supplement her diet with folic acid, taking a full dose of aspirin (325 mg) and folate supplementation. She should discuss raising her dose of atorvastatin (Lipitor) with her PCP, because her cholesterol and LDL levels were high this admission and she has an outpt appointment for carotid non-invasive studies 4/0/03.
|
Has this patient ever been on amlodipine
|
{
"answer_end": [
508
],
"answer_start": [
451
],
"text": [
"Amlodipine 10 mg PO QD Food/Drug Interaction Instruction,"
]
}
|
The patient is a 62-year-old white male with a long-standing hypotension of 30 to 40 mmHg who is treated with hypoglycemics and has a significant history of diabetes of 20 years without neurological or retinopathy. He also has a positive family history of cardiac risk factors and denies cigarettes. He had a percutaneous transluminal coronary angioplasty at the Ribush Bassta Syark Hospital in 1985 and has had rule outs for myocardial infarction since, with the last one approximately in 1990 at Dormro General Hospital. At 1:00 a.m., the patient had recurrent chest pain and took four to five Nitroglycerins without relief and was front-loaded with TPA, Heparin, Aspirin, Morphine sulfate, and Nifedipine. The patient was placed on an intra-aortic balloon pump in preparation for coronary artery bypass surgery and was discharged on prophylactic anticoagulation with Coumadin, taking Diltiazem 60 t.i.d., Glyburide, and Lisinopril 20 PO q.day. The patient had a coronary artery bypass graft x three with a saphenous vein graft to the LAD, first branch of the obtuse marginal and the posterior descending artery. On postoperative day #3, the patient had atrial fibrillation which was treated and controlled pharmacologically, and he was requested to follow-up with Dr. Schoening in 6 weeks and his cardiologist in 2 weeks.
|
Has the patient ever tried diltiazem
|
{
"answer_end": [
907
],
"answer_start": [
880
],
"text": [
"taking Diltiazem 60 t.i.d.,"
]
}
|
Mr. Legions is a 54 year old professor who presented to Menjack Hospital Medical Center with recurrent substernal chest pain one day after coronary artery bypass graft (5 vessel bypass) 8 years ago. His coronary risk factors include a positive family history and a previous diagnosis of hyperlipidemia. He was given Lovastatin 40 mg q q.m. and 20 mg q p.m., as well as enteric-coated aspirin one tablet q day. At Skaggssin Hospital, he was given IV nitroglycerin, IV heparin, Nifedipine SL, and morphine, in addition to aspirin and Lovastatin. The patient's pain was relieved with four sublingual nitroglycerin and an EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. He was treated symptomatically with Tylenol and started on Biaxin 500 mg po bid, and also received a five day course of oral Biaxin with Cholestyramine one packet po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn. The patient had episodes of fever, achieving a maximum temperature of 101.4, and a chest x-ray on 0/26/95 demonstrated evidence of early congestive heart failure. The patient was treated with daily doses of IV Lasix with resolution of his rales. He was admitted to the Cardiac Intensive Care Unit on IV heparin and nitroglycerine as well as continuation of his aspirin and Lovastatin. His pain was treated with morphine sulfate and relieved with four sublingual nitroglycerin. An EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. After 24 hours pain-free, the patient was transferred to the Cardiac Step-Down floor and the IV nitroglycerin and IV heparin were discontinued. An echocardiogram demonstrated inferior and posterior hypokinesis with an ejection fraction of approximately 46%, and the patient underwent a submax MIBI to assess coronary perfusion of the heart. The exercise component of this examination demonstrated EKG changes consistent with ischemic coronary flow. Nuclear imaging demonstrated a fixed apical lateral defect in the patient's heart consistent with a healed or healing transmural infarct. The patient also complained of progressive anterior and lateral thigh pain, symptoms consistent with an upper respiratory viral infection, and rales 4 to 5 cm above the bases bilaterally. He was discharged to home with followup in MERH under Drs. Dwayne Ariel Bremme with the medications Enteric-coated aspirin 325 mg po q day, Cholestyramine one packet po q hs, Lovastatin 20 mg po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn with chest pain.
|
Has patient ever been prescribed nitroglycerin
|
{
"answer_end": [
634
],
"answer_start": [
544
],
"text": [
"The patient's pain was relieved with four sublingual nitroglycerin and an EKG demonstrated"
]
}
|
Patient Damion Prehn, a 60 year old male with coronary artery disease, hypertension, and hyperlipidemia, was admitted with increasing shortness of breath and intermediate MIBI as an outpatient in the setting of significant deconditioning and multiple cardiac risk factors. In the ED, his temperature was 98.6, his pulse was 70, his blood pressure was 141/69, and his saturation was 94% on room air. He was given ASA and Keflex for LE cellulitis, and his cardiac markers were negative. A cath revealed Subtotal RCA occlusion, 80% OM, and 50% mid LAD, and Cypher stents were placed in mid RCA to os and wedge elevated. EF 45% on stress echo and monitoring revealed 2 episodes of NSVT post-PCI. He was started on Atenolol 125 mg PO daily, Lipitor (Atorvastatin) 80 mg PO daily, Keflex (Cephalexin) 500 mg PO QID, Plavix (Clopidogrel) 75 mg PO daily, Enteric Coated ASA 325 mg PO daily, Lasix (Furosemide) 80 mg PO BID, Potassium Chloride Slow Rel. (KCL Slow Release) 10 MEQ PO daily, LISINOPRIL 5 MG PO DAILY, MICONAZOLE NITRATE 2% CREAM TP BID, MICONAZOLE NITRATE 2% POWDER TOPICAL TP BID, NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 0.5 GM PO QPM with instructions to take aspirin 30 minutes before-hand to prevent facial flushing. Alerts were overridden due to SERIOUS INTERACTION: MICONAZOLE NITRATE & ATORVASTATIN CALCIUM, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM, POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & MICONAZOLE NITRATE, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 and POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL. He was discharged on 9/23/06 with code status full code and disposition home, a diet of house/low chol/low sat. fat, and instructions to measure weight daily and resume regular exercise. Follow up appointments were scheduled with Dr. Weakland, Primary Care 1-2 weeks and Dr. Trouser, Cardiology 571-491-1951 Please call in 1-2 days if you do not hear from the office. You must be seen in 2-4 weeks. Allergy is to Shellfish. ASA/Plavix were continued at current doses x 1 year, increased lasix from 40 mg PO daily to 80 mg PO BID, increased b-blocker, continued norvasc, and stopped isordil. Low dose potassium 10mEq was started as increased lasix, and lisinopril 5mg PO daily was started to prevent facial flushing. Patient was instructed to take aspirin 30 minutes before hand to prevent serious interaction between miconazole nitrate and atorvastatin calcium/simvastatin, and potassium chloride immediate rel. PO was ordered. Instructions were given to continue toe cream, check lytes in 2 days, and come to the ER if any concerning symptoms such as trouble breathing, chest pain, or leg swelling. Do NOT discontinue these medications without speaking to your doctor.
|
has there been a prior lasix ( furosemide )
|
{
"answer_end": [
915
],
"answer_start": [
883
],
"text": [
"Lasix (Furosemide) 80 mg PO BID,"
]
}
|
A 45-year-old female with a history of IDDM, sleep apnea, asthma on chronic prednisone, HTN, and CAD s/p NSTEMI in 6/10 with a stent to the LAD presented with 3 days of worsening dyspnea and chest pressure. She was treated for an asthma exacerbation with Prednisone 40 mg PO QAM x 10 doses, Instructions: Taper: 40mg for 2 days, then 35mg for 2days, then 30mg for 2days, then 25mg for 2days, then 20mg, ECASA (ASPIRIN ENTERIC COATED) 325 mg PO QD, CARDIZEM SR (DILTIAZEM SUSTAINED RELEASE) 120 mg PO QD, Override Notice: Override added on 0/9/05 by DUHART, RANDY M., M.D. on order for LOPRESSOR PO (ref #31219927), POTENTIALLY SERIOUS INTERACTION: DILTIAZEM HCL & METOPROLOL TARTRATE Reason for override: aware, HYDROCHLOROTHIAZIDE 25 MG PO QD, LISINOPRIL 30 MG PO QD, on order for POTASSIUM CHLORIDE IMMED. REL. PO (ref #73021085), POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: aware, LORAZEPAM 0.5 MG PO BID PRN Anxiety, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO BID, on order for CARDIZEM SR PO (ref #76249027), on order for CARDIZEM PO (ref #49626929), COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, ADVAIR DISKUS 500/50 (FLUTICASONE PROPIONATE/...), ATOVAQUONE 750 mg PO BID, NAPROSYN (NAPROXEN) 250-500 mg PO BID PRN Pain, CALCIUM CARB + D (600MG ELEM CA + VIT D/200 IU), ZOLOFT 1 TAB PO QD, Alert overridden: Override added on 4/2/05 by : POTENTIALLY SERIOUS INTERACTION: CLOPIDOGREL BISULFATE & NAPROXEN Reason for override: musculoskeletal pain, diabetes mellitus 2/2 chronic steroid use, Ischemia: continue Zocor, Clopidogrel, ECASA, nitrates as needed., Pump: continue lisinopril, HCTZ, Cardizem, Lopressor 12.5 mg PO BID, presentation. Never hospitalized, chronic prednisone therapy, s/p gentle diuresis, Pred, nebs with improvement of symptoms, D-dimer < 200, admission peak flow 150 (baseline NL 300-350), at discharge 275-300, ambulatory O2 sat WNL., Musculoskeletal workup showed reproducible sternal pain on palpation consistent with costochondritis and Naprosyn PRN pain, Psych: Continue Zoloft for depression and Lorazepam for anxiety, PPx was managed with PPI., Discharge condition was stable. Plan was to assess efficacy of Prednisone 20 mg upon completion of taper, status of dyspnea/asthma symptoms on low dose beta-blocker, chest pain/costochondritis with PRN NSAIDs, and ENDO: Chronic steroid use, Insulin SS in-house. -calcium/vit D supplement, with food/drug interaction instruction to give with meals and take with food, to resume regular exercise, and follow up appointments with Dr. BALVANZ, PCP in 2 weeks and ENDO indefinitely.
|
Is there a mention of of nitrates usage/prescription in the record
|
{
"answer_end": [
1620
],
"answer_start": [
1554
],
"text": [
"Ischemia: continue Zocor, Clopidogrel, ECASA, nitrates as needed.,"
]
}
|
Ms. Veltin is a 72 year old woman with a PAST MEDICAL HISTORY significant for coronary artery disease, diabetes, and hypertension. On admission, her CURRENT MEDICATIONS included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., simvastatin 10 q.d., metformin 500 q.d., and NPH 43 q.a.m. and 24 q.p.m., while her PAST MEDICAL HISTORY was significant for diabetes for which she took insulin and checked her sugars at home which ran 170 range to 200 range. During admission, she was maintained on metformin, her blood pressure was controlled with Lisinopril at 40 milligrams, she was given nifedipine extended release 120 q.d., and her sugars at home on her regimen of 43 q.a.m. and 24 q.p.m. were in control. She was also maintained on her aspirin and simvastatin, and given Lasix 20 q.d. times seven days and four liters through admission with Lasix at 40 intravenously. Her cardiovascular evaluation showed three vessel disease, diastolic dysfunction, and pulmonary artery systolic pressure of 36 plus RA, but no wall motion abnormalities. Her blood pressure regimen was advanced with the addition of Atenolol 50 b.i.d. and titration up to 120 milligrams q.d. of nifedipine extended release. For congestive heart failure, she diuresed approximately four liters through admission with Lasix at 40 intravenously and would be discharged on a seven day course of Lasix at 20 p.o. q.d. Pulmonary evaluation showed hypoxia on admission to 85% on room air, D-dymer greater than 1000, V/Q scan low probability, negative lower extremity noninvasives, chest CT without interstitial lung disease, and pulmonary function tests consistent with restrictive picture. Endocrine evaluation revealed that she was maintained on metformin during admission and also on half of her dose of NPH given her decreased p.o. intake. She took insulin and checked her sugars at home, which were 170 to 200, and she was discharged on her normal regimen of 43 q.a.m. and 24 q.p.m. of NPH. Discharge medications included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., nifedipine extended release 120 q.d., metformin 500 q.d., NPH 43 q.a.m. and 24 q.p.m., simvastatin 10 q.d., aspirin 325 q.d., and Lasix 20 milligrams p.o. q.d. times seven days. She was discharged in stable condition on March, 2000 and will follow up with Dr. Nakajima, her primary care doctor, and Dr. Klang, her cardiologist.
|
has the patient used insulin in the past
|
{
"answer_end": [
1872
],
"answer_start": [
1824
],
"text": [
"She took insulin and checked her sugars at home,"
]
}
|
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 ever been on lipitor/niacin
|
{
"answer_end": [
1325
],
"answer_start": [
1277
],
"text": [
"continue lipitor/niacin (incr lipitor 40--->80),"
]
}
|
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.
|
What is the current dose of the patient's kcl
|
{
"answer_end": [
1050
],
"answer_start": [
978
],
"text": [
"F/E/N: KCl PO replacement scale. MgSulfate sliding scale.GI: Colace PRN,"
]
}
|
This 75 year old woman with a history of hypertension, hyperlipidemia, past tobacco use, and angina presented with syncope and was found to be status post non ST elevation myocardial infarction. She was treated with Aspirin, Heparin, Lopressor, Captopril, and Cozaar initially with heart rate and blood pressure secondary to COPD, and was started on Atrovent nebs and given fluids until she had good urine output. Cardiovascular examination revealed ischemia, ST elevation, and myocardial infarction, while Pulmonary examination revealed wheezing and renal examination showed likely dehydration. The patient is currently on Aspirin, Lisinopril, and Atenolol, and was given IV fluids for dehydration. Her neurological examination showed intact PERRL and cranial nerves II-XII, regular rate and rhythm, normal S1, S2, and no murmurs, rubs, or gallops. Respiratory examination revealed wheezing with increased respiratory phase. Abdomen was obese, non-tender, and non-distended with left groin erythematous and scaling. Extremities had no edema and 1+ dorsalis pedis pulses. Neuro examination showed alertness and 4/5 bilateral lower extremity strength with 1+ deep tendon reflexes and normal sensation. Following discharge she requires physical therapy and follow up with Gynecology for incontinence and a possible uterine prolapse.
|
heparin
|
{
"answer_end": [
244
],
"answer_start": [
195
],
"text": [
"She was treated with Aspirin, Heparin, Lopressor,"
]
}
|
Mr. Esbenshade is a 70-year-old Caucasian male with CAD, stented five years ago, known as calcific aortic stenosis with progression of exertional dyspnea. He was admitted to CSS and stabilized for surgery on 9/13/06, which included AVR with a 25 CE magna valve, CABG x2 with LIMA to LAD and SVG1 to PDA, pulmonary vein isolation, and left atrial appendage resection, with no complications. He is currently on 5 liters of O2 and some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis, on Osmolite tube feeds at 20 mL an hour, with prophylactic antibiotics for chest tubes, medications IV, Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily, atorvastatin 20 mg daily, Neurontin 100 mg t.i.d., metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d. Cardiac meds include Aspirin, Lopressor, and Coumadin. He has been followed by psych for postoperative confusion/possible suicidal ideation, with Celexa ordered per psych. He is also on Acetaminophen 325-650 mg q. 4h. p.r.n. pain or temperature greater than 101, DuoNeb q. 6h. p.r.n. wheezing, enteric-coated aspirin 81 mg daily, Dulcolax 10 mg PR daily p.r.n. constipation, Celexa 10 mg daily, Colace 100 mg t.i.d., Nexium 20 mg daily, K-Dur 10 mEq daily for five days, Toprol-XL 200 mg b.i.d., miconazole nitrate powder topical b.i.d., Niferex 150 mg b.i.d., simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily, INR, and Boudreaux's Butt Paste topical apply to effected areas. He has been running a bit fast in Afib and is on Coumadin and aspirin for atrial fibrillation, and is awaiting a rehabilitation bed. Cipro x3 days has been started due to a UA from 10/5/06 with probable enterogram-negative rods. His mood has improved and beta-blocker has been titrated. He has been advised to make all follow-up appointments, local wound care, wash wounds daily with soap and water, shower patient daily, keep legs elevated while sitting/in bed, watch all wounds for signs of infection, redness, swelling, fever, pain, discharge, and to call PCP/cardiologist or Anle Health Cardiac Surgery Service at 282-008-4347 with any questions.
|
Has the patient ever had coumadin
|
{
"answer_end": [
671
],
"answer_start": [
605
],
"text": [
"Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily,"
]
}
|
A 45-year-old man with a history of familial cardiomyopathy and status post cardiac transplant in 2002, and chronic renal insufficiency presented with greater than two weeks of polyuria, polydipsia, blurry vision, muscle cramps, and myalgias and reported approximately a 15-pound weight loss over three weeks with decrease in usual lower extremity edema. On admission, notable for a blood glucose of 1064, creatinine 2.2 from a baseline of 1.8, sodium 130, potassium 4.9. Endocrine service was consulted and the patient was controlled with a combination regimen of Lantus, Novolog q. a.c., combined with a Novolog sliding scale. The patient was discharged with followup with Napoleon Mettee, the diabetic teaching nurse and with Dr. Jonson in the diabetes clinic and with VNA services to assist with home medications. The patient had mild acute gout flare during admission for which he was started on colchicine. The patient was discharged with medications including Calcium carbonate 1250 mg t.i.d., Cartia XT 300 mg daily, CellCept 1500 mg b.i.d., colchicine 0.6 mg daily p.r.n., Neoral 150 mg b.i.d., folate 1 mg daily, K-dur 20 mg daily, magnesium oxide 400 mg b.i.d., methotrexate 2.5 mg daily, Pravastatin 20 mg daily, prednisone 7 mg daily, Rocaltrol 0.25 mg daily, Synthroid 150 mcg daily, Torsemide 40 mg daily, Vitamin C, Vitamin E, and cyclosporin 150 mg b.i.d., Vitamin C 500 mg b.i.d., Rocaltrol 0.25 mcg daily, calcium carbonate 500 mg t.i.d., colchicine 0.3 mg p.o. b.i.d., cyclosporin 150 mg b.i.d., folic acid 1 mg daily, Synthroid 150 mcg daily, magnesium oxide 420 mg b.i.d., prednisone 7.5 mg q.a.m., Vitamin E 400 units daily, Pravachol 20 mg at night, Cartia XT that is diltiazem extended release 300 mg daily, CellCept 1500 mg b.i.d., Lantus insulin (Glargine) 40 units subcutaneous q.a.m., Novolog 12 units before breakfast, Novolog 12 units before lunch, Novolog 14 units before dinner, and Novolog sliding scale q. a.c. The patient demonstrated proper understanding of blood glucose testing and insulin administration prior to discharge.
|
has the patient had magnesium oxide
|
{
"answer_end": [
1172
],
"answer_start": [
1142
],
"text": [
"magnesium oxide 400 mg b.i.d.,"
]
}
|
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o.
|
has there been a prior that medicine
|
{
"answer_end": [
2540
],
"answer_start": [
2483
],
"text": [
"while in the hospital and was discharged on that medicine"
]
}
|
This 39-year-old female with a history of discoid lupus and pericarditis presented with severe substernal chest pain after having prednisone and Plaquenil discontinued. She first developed arthralgias of various joints, which were treated with aspirin, Motrin and steroids. In 1985, she developed pleuritic substernal chest pain and was diagnosed at Westten Hospital with pericarditis. In 1988, she was seen at the Arthritis Clinic by Dr. Goerlitz and was treated with Plaquenil 200 bid, plus aspirin and Naprosyn. In 22 of May, she was diagnosed with a lupus flare and was put on prednisone 30 q am and in 23 of March, the steroids were tapered off and discontinued. However, she presented with increasing joint pain and had her prednisone restarted with Plaquenil 200 bid, Motrin 80 tid, prednisone 10 q am, Dilantin 200 bid, and prednisone 30 q day. Laboratory examination showed electrolytes within normal limits, CK of 76, white count of 4.7, hematocrit of 30, platelets of 352,000, mean corpuscular volume of 83, ESR of 88, oxygen saturation of 99% on room air, and urinalysis showed specific gravity of 1.026, 2+ protein, 10 to 15 white cells, 8 to 10 red blood cells and a few granular casts. Chest x-ray showed increased heart size, multiple thoracic compression fractures and osteopenia, and electrocardiogram showed sinus rhythm with frequent premature ventricular contractions at a rate of approximately 70. She was ruled out for a myocardial infarction, had an echocardiogram which showed a small amount of pericardial fluid, and was placed back on her Plaquenil 200 bid and prednisone 30 q day. The hematocrit remained stable between 27 and 30 without transfusions or further intervention, and she was discharged on medications including Plaquenil 200 bid, prednisone 20 q day, Dilantin 400 q day, L-thyroxine 0.2 q am, Motrin 800 tid, Carafate, iron and folate for follow-up in Rheumatology Clinic with Dr. Grondin.
|
Was the patient ever prescribed naprosyn.
|
{
"answer_end": [
528
],
"answer_start": [
469
],
"text": [
"Plaquenil 200 bid, plus aspirin and Naprosyn. In 22 of May,"
]
}
|
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 is the current dose of protonix
|
{
"answer_end": [
2112
],
"answer_start": [
2091
],
"text": [
"Protonix 40 mg daily."
]
}
|
EVANKO, BENEDICT 205-94-27-9, a 66-year-old Spanish-speaking male was admitted with chest pressure initially on exertion, most recently at rest, for which he took two nitroglycerin tablets with good resolution and worsening lower extremity edema and a 30-pound weight gain over the past few months due to missing his medications and eating a lot of salt. On examination, he was afebrile with HR in the 60s and BP 110/100% RA. Tests performed revealed pulmonary edema on CXR. He was prescribed Acetylsalicylic Acid 81 mg PO daily, Atorvastatin 80 mg PO daily, Coreg (Carvedilol) 3.125 mg PO BID, Plavix (Clopidogrel) 75 mg PO daily, Lasix (Furosemide) 80 mg PO daily starting in the morning, Insulin 70/30 Human 50 units QAM and 35 units QPM SC, Imdur ER (Isosorbide Mononitrate (SR)) 30 mg PO daily, hold Lisinopril 10 mg PO daily if SBP < 90, Potentially serious interaction: Spironolactone 50 mg PO daily, hold if SBP < 90, Potentially serious interaction: Potassium Chloride &, Metamucil Sugar Free (Psyllium (Metamucil) Sudafed) 1 packet PO daily, KCL Immediate Release PO, Potassium Chloride Immediate Release PO, Captopril PO, Insulin Aspart Sliding Scale (subcutaneously) SC AC, If BS is < 125, then give 0 units subcutaneously, Lipitor 80, Lovenox 100 sq., ACEi started and increased to 10mg QD, NPH 18 BID (increased from home 10), 6U AC and SS, Hgb A1C 10.4 indicating need for tighter glucose control, Diuresed well with weight on DC of 82kg, Sinus with long PR interval, Cardiogenic Pulm Edema, Mild Transaminitis decreased, Alk Phos continues to be elevated at 175, Left Foot Pain, Degenerative Changes. He was started on Lasix 80 IV, Acetylsalicylic Acid 81 mg PO daily, Atorvastatin 80 mg PO daily, Coreg (Carvedilol) 3.125 mg PO BID, Plavix (Clopidogrel) 75 mg PO daily, Lasix (Furosemide) 80 mg PO daily starting in the morning, Insulin 70/30 Human 50 units QAM and 35 units QPM SC, Imdur ER (Isosorbide Mononitrate (SR)) 30 mg PO daily, Lisinopril 10 mg PO daily (hold if SBP<90), and Spironolactone 50 mg PO daily (hold if SBP<90), Potentially Serious Interaction: Potassium Chloride &, Potentially Serious Interaction: Spironolactone &, Insulin Aspart Sliding Scale (subcutaneously) SC AC, and Metamucil Sugar Free (Psyllium (Metamucil) Sugar Free) 1 packet PO daily, Potassium Chloride Immediate Release PO (ref #). He was free of chest pain since Sunday and was discharged with fluid restriction, a low-chol/low-sat fat diet, 2 gram Sodium diet, and walking as tolerated, and was advised to take all his medications as directed, adjust insulin as needed, and check his blood sugars in the morning and with meals, and keep tight control over his blood sugar. He was also scheduled for follow-up appointments with Cardiology Dr. Lelonek 714.815.2497 1-4 weeks and PCP Dr. Hoyt Shimek 556-913-5202 2 weeks.
|
Has this patient ever been treated with acei
|
{
"answer_end": [
1303
],
"answer_start": [
1265
],
"text": [
"ACEi started and increased to 10mg QD,"
]
}
|
A 59 year-old woman with metastatic breast cancer and a history of pulmonary embolism presented with symptoms of fatigue, lethargy, tachycardia and fever. CXR showed LLL opacity, LUL opacity and hilar fullness on the right with prominent bronchi (?cuffing) and vertebral fractures. She was admitted with bacteremia on 7/0/2006 and treated with whole brain radiotherapy in March 2006 and with weekly Taxol. Restaging studies showed stable visceral disease but progression of bony metastatic disease, so in January 2006, she initiated a second-line Navelbine therapy. At the ER, she was administered 1UPRBC, 1L NS, Levofloxacin 500 mg IV, and placed CVP~20. Her blood pressure systolic initially 120s but decreased to 90s (MAPS>70), and norepinephrine was administered. She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN Pain, Temperature greater than:101, Other:transfusion premedication, ALBUTEROL NEBULIZER 2.5 MG INH Q4H PRN Wheezing, TESSALON PERLES (BENZONATATE) 100 MG PO TID PRN Other:congestion, BENADRYL (DIPHENHYDRAMINE) 12.5 MG PO x1 PRN Other:pre-transfusion, COLACE (DOCUSATE SODIUM) 100 MG PO BID PRN Constipation, ENOXAPARIN 40 MG SC DAILY, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, FLOVENT HFA (FLUTICASONE PROPIONATE) 110 MCG INH BID, INSULIN ASPART Sliding Scale.
|
What medications have been previously used for the treatment of temperature
|
{
"answer_end": [
829
],
"answer_start": [
768
],
"text": [
"She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN Pain,"
]
}
|
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.
|
What was the dosage prescribed of dilaudid ( hydromorphone hcl )
|
{
"answer_end": [
925
],
"answer_start": [
874
],
"text": [
"DILAUDID (HYDROMORPHONE HCL) 0.5 MG PO Q4H PRN Pain"
]
}
|
Stansbury Ellsworth, a 59-year-old female with NIDDM, GERD, HTN, Depression, and known CAD s/p circumflex stent 2002, was admitted with atypical chest pain. Her EKG showed NSR 79 bpm, normal axis and intervals, with 1 mm ST segment depression V3-V5, and inverted Ts in V3-V5. Her CXR was negative for effusions, infiltrates, edema, and normal bony structures. A Mibi on 10/22 showed small perfusion defect without reversibility. Her esophagitis responded quickly to KBL and DIFLUCAN with her tolerating PO on AM of discharge. She was prescribed CLONAZEPAM 0.5 MG PO QD, LISINOPRIL 5 MG PO QD, POTASSIUM CHLORIDE IV, POTASSIUM CHLORIDE PO, MOM (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO QD, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, PROTONIX (PANTOPRAZOLE) 40 MG PO QD, LIPITOR (ATORVASTATIN) 20 MG PO QHS, ATENOLOL 25 MG PO QD, ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, REMERON (MIRAZAPINE) 15 MG PO QHS, CELEXA (CITALOPRAM) 20 MG PO QD, METFORMIN 500 MG PO BID, DIFLUCAN (FLUCONAZOLE) 100 MG PO QD X 12 doses, and KCL IMMEDIATE RELEASE PO. Overrides were added for DIFLUCAN PO (ref #62332050) and KCL IMMEDIATE RELEASE PO (ref # 57130577) due to POTENTIALLY SERIOUS INTERACTIONS: CLONAZEPAM & FLUCONAZOLE and LISINOPRIL & POTASSIUM CHLORIDE, respectively. She was to continue with remeron, celexa, and clonazepam, and was prescribed MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and MOM (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO QD Starting Today (9/4) PRN Constipation, Upset Stomach. She will complete two-week course of FLUCONAZOLE, with consideration of an outpatient EGD if symptoms do not improve with treatment. She was discharged in stable condition.
|
Has this patient ever been treated with celexa ( citalopram )
|
{
"answer_end": [
949
],
"answer_start": [
917
],
"text": [
"CELEXA (CITALOPRAM) 20 MG PO QD,"
]
}
|
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--->
|
Was the patient on any medication for her pain
|
{
"answer_end": [
440
],
"answer_start": [
409
],
"text": [
"Oxycodone 5 MG PO Q6H PRN Pain,"
]
}
|
Mr. Wizar is a 51-year-old man who was admitted for repair of left pseudoaneurysm in his groin and was given wet-to-dry dressing changes t.i.d. On 6/3/2003, he was taken to the operating room for left groin closure with flap by Plastic Surgery and Vascular Surgery. He was injected with heparin solution and received serial needle pricks, which improved the appearance of the flap. He was given vancomycin, levofloxacin, and Flagyl for empiric treatment for C. diff, with C. diff cultures being negative on 0/7/2003 and drain cultures showing rare Staphylococcus aureus on 10/6/2003. His Zestril was held secondary to an elevation in creatinine, which gradually resolved. He was also seen by Cardiology and Nutrition and was given supplements, vitamin C, and Zinc for wound healing, with the flap being stable, pink, and viable at the time of discharge. His discharge medications included Aspirin 325 mg once a day; digoxin 0.125 once a day; Ultralente 16 units q.a.m. , 4 units q.p.m.; Zocor 10 mg once a day; Toprol 25 mg once a day; Imdur 30 mg once a day; torsemide 100 mg once a day; lisinopril 2.5 mg once a day; colace; and Percocet.
|
What is the current dose of aspirin
|
{
"answer_end": [
915
],
"answer_start": [
854
],
"text": [
"His discharge medications included Aspirin 325 mg once a day;"
]
}
|
Mr. Slunaker is a 56-year-old gentleman who underwent coronary artery bypass grafting x4 and was discharged to home in stable condition on 10/20/06. He presented to see Dr. Emory Bebeau in clinic with a warm and swollen left lower leg with redness and was placed on levofloxacin and vancomycin and had him admitted for left lower leg cellulitis. On admission, he was taking Toprol 25 mg daily, diltiazem 30 mg t.i.d., aspirin 325 mg daily, Lasix 40 mg daily, atorvastatin 40 mg daily, Tricor 145 mg daily, Zetia 10 mg daily, metformin 500 mg daily and potassium chloride slow release 20 mEq daily. Infectious disease was consulted and recommended discontinuing the vancomycin and levofloxacin and changing to Ancef 1 gm IV q.8h. and monitoring his wound. The patient remained afebrile and his white count trended down and leg wound improved on exam. On the day of discharge, he was evaluated by Dr. Manvelyan and cleared for discharge to home with Augmentin 875/125 mg b.i.d. for a total of 10 days, enteric-coated aspirin 325 mg daily, Lipitor 40 mg daily, diltiazem 30 mg t.i.d., Zetia 10 mg daily, Tricor 145 mg nightly, Diflucan 200 mg daily for one dose for a penile yeast infection, due to antibiotic use, Metformin 500 mg q.p.m., Toprol-XL 25 mg daily and oxycodone 5-10 mg q.4h. p.r.n. pain. He was instructed to monitor his leg wound and call if he had any increased weight, temperature greater than 101 degrees, any drainage from the wound, redness, swelling or change of any kind in his leg wound. He was cleared by Infectious Disease Service and discharged to home in stable condition and will follow up with Dr. Noah Schaffhauser on 5/7/06 at 1 o'clock, Dr. Aaron Phung in three-four days, his primary care physician, and his cardiologist, Dr. Jonathon Sopata in one to two weeks.
|
What is the reason this patient is on diflucan
|
{
"answer_end": [
1211
],
"answer_start": [
1124
],
"text": [
"Diflucan 200 mg daily for one dose for a penile yeast infection, due to antibiotic use,"
]
}
|
Patient, a 37 year old male with multiple admissions for atypical chest pain, morbid obesity, restrictive lung disease by PFTs, sleep apnea, and borderline hypertension, came in complaining of SOB and "asthma attack" and anxiety. He responded well to Nebs and Ativan in the ED and was discharged with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QD with Food/Drug Interaction Instruction to take consistently with meals or on empty stomach, Klonopin (Clonazepam) 1 MG PO TID, Colace (Docusate Sodium) 100 MG PO BID, Prozac (Fluoxetine HCL) 20 MG PO QD, Zestril (Lisinopril) 10 MG PO QD, Niferex-150 150 MG PO BID, Percocet 1 TAB PO Q6H X 7 Days Starting Today (6/1) PRN pain, Azithromycin 250 MG PO QD X 4 Days Starting IN AM (6/1) with Food/Drug Interaction Instruction to take with food, Prednisone Taper PO (60 mg QD X 2 day(s) (0/22/01-09), then 50 mg QD X 2 day(s) (2/26/01-09), then 40 mg QD X 2 day(s) (9/28/01-09), then 30 mg QD X 2 day(s) (4/0/01-09), then 20 mg QD X 2 day(s) (8/26/01-09), then 10 mg QD X 2 day(s) (2/20/01-10), then 5 mg QD X 2 day(s) (3/6/01-10)), on order for Azithromycin PO (ref # 63922816) with Potentially Serious Interaction: Clonazepam & Azithromycin, Prilosec (Omeprazole) 20 MG PO QD, Albuterol Inhaler 2 Puff Inh QID, Atrovent Inhaler (Ipratropium Inhaler) 2 Puff Inh QID, and was instructed to return to work after an appointment with a local physician. He was discharged with a diagnosis of sob of unknown etiology, and other diagnoses included borderline HTN, anxiety disorder, PPD, and morbid obesity.
|
What medications has this patient tried for pain
|
{
"answer_end": [
693
],
"answer_start": [
632
],
"text": [
"Percocet 1 TAB PO Q6H X 7 Days Starting Today (6/1) PRN pain,"
]
}
|
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 medications, if any, has the patient tried for presumed hospital aquired pna in the past
|
{
"answer_end": [
3195
],
"answer_start": [
3109
],
"text": [
"pt was begun on ceftaz and levo for gram pos coverage (levo) double gram neg coverage,"
]
}
|
The patient is a 55 year old male with a history of noninsulin dependent diabetes mellitus, a significant heavy smoking history, and a family history of cardiac disease who was admitted with chest pain and worsening right great toe ulceration with lymphangitis. He had completed a course of Cipro and was given a dose of oxacillin before being sent to Sidecrestso Community Hospital for IV antibiotics and work-up. MEDICATIONS ON ADMISSION included Tylenol #3 and glyburide 10 mg p.o. q. day. No known drug allergies. He was then treated for the right toe cellulitis with IV antibiotics of gentamicin and Clindamycin, and was placed on atenolol with the dose increased to 75 mg p.o. q. day. On discharge, the patient was switched from Nitropaste to Isordil 10 mg p.o. t.i.d., and his glyburide was increased to 20 mg p.o. q. day. MEDICATIONS ON DISCHARGE included atenolol, aspirin, 325 mg po q day, Glyburide, 20 mg po q day, Tylenol #3, two tablets po x one p.r.n. for pain, and sublingual nitroglycerin, p.r.n. The patient was discharged to home and was to follow-up with Dr. Netti as an outpatient and with Dr. Frasso of AMH Cardiology.
|
Has this patient ever been treated with gentamicin
|
{
"answer_end": [
617
],
"answer_start": [
567
],
"text": [
"with IV antibiotics of gentamicin and Clindamycin,"
]
}
|
Lupe Rumble, a 42 year old female with a history of asthma, hypertension, obesity, hyperlipidemia, hyperglycemia, hirsutism, chiari malformation, spinal stenosis, and spinal syrinx, was admitted to the hospital with a recent asthma flare, productive cough, low grade fevers, shortness of breath, and wheezing. Her chest x-ray showed a linear opacity in the right lower lobe most consistent with platelike atelectasis, but could not rule out resolving or new pneumonia. Treatment included ALBUTEROL INHALER 2 PUFF INH QID, ALBUTEROL NEBULIZER 2.5 MG NEB Q4H, Advair Diskus 500/50 (Fluticasone Propionate/...), Combivent (Ipratropium and Albuterol Sulfate) 2 PUFF INH TID, LISINOPRIL 20 MG PO DAILY, Singulair (Montelukast) 10 MG PO DAILY, and a prednisone taper starting at 60 mg q 24 h x 2 doses, then 50 mg daily x 3 days, then 40 mg daily x 3 days, then 30 mg daily x 3 days, then 20 mg daily x 3 days, and then 10 mg daily x 2 days and stop. The peak flow had improved to 250 and ambulating oxygen saturation was 92-94% at discharge. The patient was also advised to try a nicotine patch and was given Lovenox as a prophylaxis. Her lisinopril was increased to 20mg due to hypertension, and she was discharged on order for KCL IMMEDIATE RELEASE PO (ref #) with instructions to continue all home medications, a prednisone taper, nebs, and advair, singulair, albuterol, and combivent. Smoking cessation was encouraged and she was interested in trying a nicotine patch.
|
What medications has the patient been prescribed for hypertension.
|
{
"answer_end": [
1187
],
"answer_start": [
1130
],
"text": [
"Her lisinopril was increased to 20mg due to hypertension,"
]
}
|
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.
|
Why has the patient been prescribed glyburide
|
{
"answer_end": [
1287
],
"answer_start": [
1237
],
"text": [
"To better manage blood sugars, glyburide was added"
]
}
|
Mary Urbieta, a 56-year-old male with a history of ESRD, CAD, and CHF (EF 20-25%), was admitted to the hospital with Hypotension and NSTEMI. Upon discharge he was placed on a Full Code status, a renal diet (FDI), and walking as tolerated, and was instructed to avoid grapefruit unless MD instructs otherwise. His BP was 66/30 after 5.5 liters were removed, and rose to 73/40 after 1 liter of NS was given. Labs showed WBC 5, TnI 0.37, CK 153, CKMB 8.2, and EKG NSR, 1st deg AVB, LAE, LVH, old TWI in 1, L, V5, V6, more pronounced ST dep in V5 than 6/4, and CXR R pl effusion, CMG. Ischemia was managed with medical management with Asa, Beta Blocker, Imdur, Zocor, NTG PRN, and a PET scan was ordered to assess for viable myocardium and ischemia. The results showed a small region of myocardial scar/hibernation along with mild residual stress induced peri-infarct ischemia in the distal LAD distribution and moderate global LV systolic dysfunction, essentially unchanged from his prior study of February 2003. A BNP was sent and pending, and an echo revealed EF 30% and mod AI. He was placed on Acetysalicylic Acid 325 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, Enalapril Maleate 10 mg PO BID, NPH Humulin Insulin 2 units QAM; 3 units QPM SC 2 units QAM 3 units QPM, NTG 1/150 (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 PRN chest pain, Zocor (Simvastatin) 40 mg PO QHS, on order for Nephrocaps PO (ref #12327843), Potentially Serious Interaction Simvastatin & Niacin, Vit. B-3 Reason for override: home regimen, Imdur (Isosorbide Mononit.(SR)) 30 mg PO QD, Nephrocaps (Nephro-Vit RX) 2 tab PO QD, Nexium (Esomeprazole) 20 mg PO QD, Toprol XL (Metoprolol (Sust. Rel.)) 200 mg PO QHS, Persantine and viability cardiac PET scan 5/19/04, and SQ heparin for DVT prophylaxis. He was alerted to the Definite Allergy (or Sensitivity) to ACE Inhibitors. Follow-up appointments were made with the cardiologist, primary care physician, and Dr Alan Mcratt, and the family was called to stress the importance of follow up with the cardiologist, Dr Ivrin, and to adhere to dietary restrictions, fluid intake, and medications.
|
Has the patient taken any medications for his bp management
|
{
"answer_end": [
405
],
"answer_start": [
361
],
"text": [
"rose to 73/40 after 1 liter of NS was given."
]
}
|
Mr. Slunaker is a 56-year-old gentleman who underwent coronary artery bypass grafting x4 and was discharged to home in stable condition on 10/20/06. He presented to see Dr. Emory Bebeau in clinic with a warm and swollen left lower leg with redness and was placed on levofloxacin and vancomycin and had him admitted for left lower leg cellulitis. On admission, he was taking Toprol 25 mg daily, diltiazem 30 mg t.i.d., aspirin 325 mg daily, Lasix 40 mg daily, atorvastatin 40 mg daily, Tricor 145 mg daily, Zetia 10 mg daily, metformin 500 mg daily and potassium chloride slow release 20 mEq daily. Infectious disease was consulted and recommended discontinuing the vancomycin and levofloxacin and changing to Ancef 1 gm IV q.8h. and monitoring his wound. The patient remained afebrile and his white count trended down and leg wound improved on exam. On the day of discharge, he was evaluated by Dr. Manvelyan and cleared for discharge to home with Augmentin 875/125 mg b.i.d. for a total of 10 days, enteric-coated aspirin 325 mg daily, Lipitor 40 mg daily, diltiazem 30 mg t.i.d., Zetia 10 mg daily, Tricor 145 mg nightly, Diflucan 200 mg daily for one dose for a penile yeast infection, due to antibiotic use, Metformin 500 mg q.p.m., Toprol-XL 25 mg daily and oxycodone 5-10 mg q.4h. p.r.n. pain. He was instructed to monitor his leg wound and call if he had any increased weight, temperature greater than 101 degrees, any drainage from the wound, redness, swelling or change of any kind in his leg wound. He was cleared by Infectious Disease Service and discharged to home in stable condition and will follow up with Dr. Noah Schaffhauser on 5/7/06 at 1 o'clock, Dr. Aaron Phung in three-four days, his primary care physician, and his cardiologist, Dr. Jonathon Sopata in one to two weeks.
|
has there been a prior augmentin
|
{
"answer_end": [
999
],
"answer_start": [
948
],
"text": [
"Augmentin 875/125 mg b.i.d. for a total of 10 days,"
]
}
|
A 57 year old woman with multiple cardiac risk factors presented with substernal chest pain relieved by two sublingual nitroglycerins, nausea, and an acid taste. She was ruled out for myocardial infarction by enzyme sets respectively, with no change in EKGs. Her physical examination was afebrile with a blood pressure of 132/96, pulse 95, on one liter of oxygen, saturation of 97%, and respiratory rate of 20. She was treated with aspirin, beta blockers, and nitroglycerin and was started on Axid for possibility of gastroesophageal reflux disease, as well as provided with Maalox and told to keep the head of the bed elevated. She was continued on Glucotrol for diabetes mellitus and was instructed on risk factor modifications, including diabetes mellitus control, controlling cholesterol and hypertension. Upon discharge she was prescribed Atenolol 100 mg p.o. q.d., Ecasa 325 mg q.d., Glucotrol 20 mg b.i.d., Hydrochlorothiazide 12.5 mg q.d., Trazadone 50 mg q.h.s., aspirin 1 q.d., Lopressor 75 mg q.d., nitroglycerin sublingual p.r.n., Ambien 5 mg q.h.s., and was instructed on the possibility of gastroesophageal reflux disease, as well as to follow-up with Dr. Jonker as an outpatient for further workup and management of gastroesophageal reflux disease, as well as following her for her cardiac disease via the risk factor modification.
|
Has the pt. ever been on ecasa before
|
{
"answer_end": [
889
],
"answer_start": [
871
],
"text": [
"Ecasa 325 mg q.d.,"
]
}
|
This is a 61-year-old gentleman with severe pulmonary hypertension secondary to chronic PEs, OSA, gout, bilateral hip replacements who presents with two falls in the past two days. He was compliant with his medication regimen and denies dietary indiscretion. He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5, initially being supertherapeutic with a daily goal of negative 500 to 1 L with IV Lasix once or twice a day as needed, his home dose being 160 mg p.o. His baseline room air oxygen saturation was 90-93% and he should use oxygen as treatment for his pulmonary hypertension and be provided with oxygen at home. He was treated for his hip pain initially with oxycodone which was changed to Dilaudid for better pain control, and he should be changed back to his home dose of oxycodone when discharged. He also has a history of gout which was exacerbated with diuresis and he is on his home doses of allopurinol and colchicine, Indocin being added and he should receive a total of three days of Indocin. Tylenol and narcotics as previously described can be used to help with his gouty pain. His GI regimen includes Nexium at home and Prilosec while an inpatient, and he should be switched back to Nexium when discharged from rehabilitation. His lab results on discharge include a creatinine of 1, hematocrit of 53.1 and INR of 2.3, potassium being 3.9 and magnesium being 2.0. The discharge medications include Coumadin 11 mg on Monday, Wednesday and Friday and 12 mg the other days of the week, Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day, hydrochlorothiazide 25 once a day, Lasix 160 IV once per day, allopurinol 200 once per day, colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain, Tylenol 500-1000 mg p.o. q.6 h. p.r.n. pain not to exceed 4 gm total from all sources in a 24-hour period, Ambien 10 mg p.o. nightly p.r.n. insomnia. He is being discharged to rehab with a followup with his cardiologist, Dr. Insco, and an appointment with Endocrinology.
|
How often does the patient take multivitamin
|
{
"answer_end": [
1600
],
"answer_start": [
1532
],
"text": [
"Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day,"
]
}
|
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.
|
Was the patient ever prescribed protonix
|
{
"answer_end": [
727
],
"answer_start": [
606
],
"text": [
"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,"
]
}
|
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->
|
Has this patient ever been treated with ecasa ( aspirin enteric coated )
|
{
"answer_end": [
212
],
"answer_start": [
168
],
"text": [
"ECASA (Aspirin Enteric Coated) 325 MG PO QD,"
]
}
|
Mr. Klaja is an 81-year-old gentleman who presented with abdominal pain and diarrhea, and an abdominal CT revealed an infectious inflammatory bowel process. Stool samples were sent for C. diff toxin and assay, all were negative, while stool cultures did not grow anything out. Empiric treatment with p.o. vancomycin was started, and the patient's abdominal pain resolved and he was afebrile by discharge. A flexible sigmoidoscopy showed colitis consistent with inflammatory etiology, and the patient was discharged with a presumed C. diff colitis diagnosis on a 2-week course of vancomycin. The patient had a DVT followed by bacteremia with multi-resistant Klebsiella pneumoniae, treated with meropenem for 14 days with the course. The patient had no evidence of acute coronary syndrome on admission, and his coronary artery disease, CHF, and chronic kidney disease were managed with MEDICATIONS: aspirin 81 mg, Plavix 75 mg, Coumadin 5 mg, digoxin 0.125 mg, Lasix 49 mg daily, lisinopril 10 mg daily, Lopressor 25 mg b.i.d., Zocor 80 mg daily, Flomax 0.4 mg daily and Flovent 110 mcg b.i.d., lactobacillus p.o. for probiotics and patient also had flex sig 2-week course p.o. vancomycin alone. He was given gentle hydration therapy with 2 liters of IV fluids, and restarted on Lasix 40 mg p.o. daily for diuresis. He was also discharged on a course of lactobacillus p.o. for probiotics, with DISCHARGE MEDICATIONS: Included aspirin 81 mg p.o. daily, Plavix 75 mg p.o. daily, digoxin 0.125 mg p.o. daily, Nexium 20 mg p.o. daily, lactobacillus 2 tabs p.o. t.i.d., metoprolol 25 mg p.o. b.i.d., simvastatin 80 mg p.o. at bed time, Flomax 0.4 mg p.o. every evening, vancomycin 250 mg p.o. every 6 hours x8 days at supertherapeutic, Coumadin 6 mg p.o. daily, Flovent 110 mcg inhale b.i.d., Lasix 40 mg p.o. daily, his daily dose at home.
|
What was the dosage prescribed of flovent
|
{
"answer_end": [
1092
],
"answer_start": [
1045
],
"text": [
"Flomax 0.4 mg daily and Flovent 110 mcg b.i.d.,"
]
}
|
This 79 year old male was admitted to OCMC on 8/9/05 with a 1 cm left renal stone that had caused left hip and flank pain with nausea and vomiting. His cardiologist, Dr. Cannizzo, was consulted and Coumadin was held for the operation. It was originally planned to reverse INR with FFP, but the patient felt throat tightness after 5 minutes of FFP transfusion and FFP was stopped. He then underwent laser lithotripsy and stent placement on 8/0/50 and tolerated the procedure well. Post-op, he had frequent PVC but cardiac enzyme was negative. On POD2, he tolerated regular diet and was ready to be discharged home with Bactrim and low dose Coumadin. He was also noticed to have an enlarged prostate and needs to follow up with Dr. Domebo for further management. The discharge medications included CAPSAICIN 0.025 % TP BID (apply to legs), LASIX (FUROSEMIDE) 40 MG PO QD, MICRONASE (GLYBURIDE) 2.5 MG PO QD, L-THYROXINE (LEVOTHYROXINE SODIUM) 50 MCG PO QD, POTENTIALLY SERIOUS INTERACTION: DIGOXIN & LEVOTHYROXINE SODIUM (Reason for override: home), PYRIDIUM (PHENAZOPYRIDINE HCL) 100 MG PO TID (PRN Other:bladder/stent pain), PROBENECID 1,500 MG PO BID, COZAAR (LOSARTAN) 75 MG PO QD (HOLD IF: sbp <100), FLOMAX (TAMSULOSIN) 0.4 MG PO QD, NEXIUM (ESOMEPRAZOLE) 40 MG PO QD, BACTRIM DS (TRIMETHOPRIM/SULFAMETHOXAZOLE DOU...) 1 TAB PO Q24H, and Number of Doses Required (approximate): 5. He was advised to follow up with his PCP for INR check and Coumadin dose adjustment, take Coumadin at 3 mg for tonight and tomorrow night, resume his regular Coumadin dose schedule, call his Coumadin clinic on Monday for follow up regarding to blood check and Coumadin dosage adjustment, no lifting more than 10 lbs., no driving while on narcotics, and call Urology office 865-655-3733 for appointment and questions.
|
Was the patient ever prescribed ffp
|
{
"answer_end": [
379
],
"answer_start": [
235
],
"text": [
"It was originally planned to reverse INR with FFP, but the patient felt throat tightness after 5 minutes of FFP transfusion and FFP was stopped."
]
}
|
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone
|
Has patient ever been prescribed flonase ( fluticasone nasal spray )
|
{
"answer_end": [
998
],
"answer_start": [
949
],
"text": [
"Flonase (Fluticasone Nasal Spray) 1 Spray INH 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.
|
has there been a prior magnesium
|
{
"answer_end": [
1220
],
"answer_start": [
1184
],
"text": [
"Magnesium oxide 280 milligrams q.d.,"
]
}
|
The patient was admitted on 4/12/04 with a right plantar surface neurotrophic ulcer, low-grade fevers and chills, and a history of diabetes mellitus, hypertension, distant past of pancreatitis, gout, neuropathy, high cholesterol, and chronic renal insufficiency. Significant labs at the time of admission included a potassium of 4.3, BUN of 38, creatinine of 3.2, and blood glucose of 187. The patient was started on 1. Lantus 100 mg q.p.m., 2. Humalog 20 units q.p.m., 4. Neurontin 300 mg t.i.d., 5. Lisinopril 40 mg q.d., 6. Allopurinol 300 mg q.d., 7. Hydrochlorothiazide 25 mg q.d., 8. Zocor 20 mg q.d., 9. TriCor 50 mg b.i.d., 10. Atenolol 25 mg q.d., 11. Eyedrops prednisolone and atropine, and 12. iron supplementation. The patient underwent an amputation of the third and fourth toe as well as metatarsal heads, and was started on Dr. Tosco's suggested antibiotics, vancomycin, levofloxacin, and Flagyl. To manage temperature greater than 101, the patient was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n., allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient was seen by Dr. Ulvan in the renal staff and by the diabetes management service by Dr. Clint Holets. Postoperative lab checkup revealed that the patient's creatinine bumped to 4.9 with a BUN of 61, and the renal service was consulted. The patient was given Lopressor 100 mg b.i.d. to control the blood pressure, and was eventually started on PhosLo and Ferrlecit as well as Epogen 10,000 units q. week. Levofloxacin was continued for a one week course, and the patient was discharged to the rehab facility with Tylenol 650 to 1000 mg p.o. q.4h. p.r.n. for temperature greater than 101, allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Lopressor 100 mg p.o. b.i.d., PhosLo 1334 mg p.o. q.a.c., Colace 100 mg p.o. b.i.d., Epogen 10,000 units delivered subcuticularly q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient is to be followed up at the rehab facility at Ing Mansy General Hospital and should follow up with the renal service and Dr. Knaub in two to three weeks and one to two weeks, respectively. The
|
Has the patient ever been on humalog
|
{
"answer_end": [
469
],
"answer_start": [
445
],
"text": [
"Humalog 20 units q.p.m.,"
]
}
|
The patient is a 42-year-old woman admitted for treatment of two pulmonary embolisms and a urinary tract infection. Twenty years ago she suffered a pulmonary embolism which was poorly documented after a tubal ligation. She was treated with heparin and Coumadin and had been well since that time. On 1 of October she underwent elective total abdominal hysterectomy secondary to fibroids and menorrhagia. Before admission, she noted shortness of breath and a temperature to 101, as well as pleuritic chest pain. Upon physical examination, her temperature was 102.5, blood pressure 110/80, heart rate 120, and O2 saturation on room air was 99%. Labs showed electrolytes within normal limits, BUN 6, creatinine 0.8, glucose 114, white count 12.2, hematocrit 26, platelets 508,000, PT 13.4, PTT 25.6. Chest x-ray showed bilateral basilar atelectasis and EKG showed sinus tachycardia at 104 with normal interval and axis. The patient was admitted and started on heparin and the PTT was quickly therapeutic. She had ultrasound of the thighs which failed to show deep venous thrombosis and underwent pulmonary angiography which showed two small pulmonary embolisms on the left side. The patient developed a UTI and was treated with ceftizoxime and converted to p.o. Bactrim. Upon discharge, the patient's condition was good and she was transferred to the Critmi Ganstown Community Medical Center under the care of Dr. Jamie Perman with a PT that was likely in the range of 18 to 20 and was discharged on Bactrim one double strength tablet p.o. b.i.d., iron sulfate 325 mg p.o. q.d., Motrin 800 mg p.o. t.i.d., Colace 100 mg p.o. t.i.d., and Coumadin 1 mg p.o. q. h.s.
|
Was the patient ever given medication for pulmonary embolism
|
{
"answer_end": [
247
],
"answer_start": [
184
],
"text": [
"documented after a tubal ligation. She was treated with heparin"
]
}
|
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 prescribed verapamil sustained release
|
{
"answer_end": [
1901
],
"answer_start": [
1838
],
"text": [
"Verapamil Sustained Release 120 mg PO QD Starting Today (10/19)"
]
}
|
Ms. Wentz, a 51-year-old female, was found to have an adenomatous polyp at the ileocecal valve, which was not amenable to colonoscopy resection. She has a past history of pulmonary embolism, diabetes mellitus type 2, obesity, hypercholesterolemia, probable COPD, hypertension, and moderate obstructive sleep apnea. The patient also has a long history of smoking, but quit five months before her admission. The patient is allergic to IV erythromycin, which causes rash. She was taking Lipitor 10 mg once a day, Metformin 500 mg in the morning, 100 mg in the afternoon, Coumadin 11 mg, and Tylenol p.r.n. for joint pain. The patient's Coumadin was withheld a week before operation and was placed on heparin. Her Coumadin was restarted on 7/3/05 and on her home dose of 11 mg. Her INR steadily increased over the course of her hospital stay up to 1.7 at her discharge. The patient was on metformin for her diabetes mellitus, which was withheld on the day of her surgery, and was placed on Regular Insulin sliding scale. She also complained of white creamy discharge from her vagina on 9/29/05 and miconazole suppository was prescribed for five days. At the time of discharge, her discharge from her vagina had resolved. The patient was discharged with DuoNeb 3/0.5 mg q.6h, Coumadin 12 mg p.o. nightly, Lipitor 10 mg p.o. once a day, Metformin p.o. 500 mg in the morning, 1000 mg in the afternoon, Colace 100 mg twice a day p.o., and Dilaudid 2-4 mg q.3h. p.o. The patient will arrange to have her INR draw on 1/1/05 with follow-up INRs to be drained every two days and INR will be followed by her primary care physician, Dr. Afonso. The patient is full code.
|
Has this patient ever been prescribed dilaudid
|
{
"answer_end": [
1457
],
"answer_start": [
1431
],
"text": [
"Dilaudid 2-4 mg q.3h. p.o."
]
}
|
Mr. Esbenshade is a 70-year-old Caucasian male with CAD, stented five years ago, known as calcific aortic stenosis with progression of exertional dyspnea. He was admitted to CSS and stabilized for surgery on 9/13/06, which included AVR with a 25 CE magna valve, CABG x2 with LIMA to LAD and SVG1 to PDA, pulmonary vein isolation, and left atrial appendage resection, with no complications. He is currently on 5 liters of O2 and some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis, on Osmolite tube feeds at 20 mL an hour, with prophylactic antibiotics for chest tubes, medications IV, Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily, atorvastatin 20 mg daily, Neurontin 100 mg t.i.d., metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d. Cardiac meds include Aspirin, Lopressor, and Coumadin. He has been followed by psych for postoperative confusion/possible suicidal ideation, with Celexa ordered per psych. He is also on Acetaminophen 325-650 mg q. 4h. p.r.n. pain or temperature greater than 101, DuoNeb q. 6h. p.r.n. wheezing, enteric-coated aspirin 81 mg daily, Dulcolax 10 mg PR daily p.r.n. constipation, Celexa 10 mg daily, Colace 100 mg t.i.d., Nexium 20 mg daily, K-Dur 10 mEq daily for five days, Toprol-XL 200 mg b.i.d., miconazole nitrate powder topical b.i.d., Niferex 150 mg b.i.d., simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily, INR, and Boudreaux's Butt Paste topical apply to effected areas. He has been running a bit fast in Afib and is on Coumadin and aspirin for atrial fibrillation, and is awaiting a rehabilitation bed. Cipro x3 days has been started due to a UA from 10/5/06 with probable enterogram-negative rods. His mood has improved and beta-blocker has been titrated. He has been advised to make all follow-up appointments, local wound care, wash wounds daily with soap and water, shower patient daily, keep legs elevated while sitting/in bed, watch all wounds for signs of infection, redness, swelling, fever, pain, discharge, and to call PCP/cardiologist or Anle Health Cardiac Surgery Service at 282-008-4347 with any questions.
|
Why was the patient prescribed aspirin
|
{
"answer_end": [
1567
],
"answer_start": [
1522
],
"text": [
"Coumadin and aspirin for atrial fibrillation,"
]
}
|
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone
|
Has this patient ever been treated with felodipine
|
{
"answer_end": [
948
],
"answer_start": [
893
],
"text": [
"Felodipine 5mg PO QD Food/Drug Interaction Instruction,"
]
}
|
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 pt. ever been on acei before
|
{
"answer_end": [
1714
],
"answer_start": [
1661
],
"text": [
"The patient was followed by the AH service with ACEi,"
]
}
|
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 the patient had coumadin
|
{
"answer_end": [
1009
],
"answer_start": [
938
],
"text": [
"The patient was not heparinized due to the fact that he was on Coumadin"
]
}
|
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.
|
What is the current dose of lisinopril
|
{
"answer_end": [
410
],
"answer_start": [
388
],
"text": [
"LISINOPRIL 5 MG PO QD,"
]
}
|
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 pt. ever been on lasix. before
|
{
"answer_end": [
1385
],
"answer_start": [
1341
],
"text": [
"He was initially diuresed mildly with Lasix,"
]
}
|
This 70-year-old woman with a complex medical history, including cerebrovascular accident x two in 1980s without deficits, seizure history probably secondary to ETOH withdrawal, hypertension x 30 years, asthma, gout, and status post repair of subclavian artery stenosis in 1993, presented to the Dagha Medical Center with severe chest pain. A chest CT revealed a 2.3 x 2.8 cm lobulated mass in the right lower lobe involving the pleura, with extensive hilar and mediastinal constitutions consistent with prior granulomatous disease, and tests were positive for multiple precarinal and right peritracheal areas of adenopathy recent from metastatic disease. The patient was admitted to the Thoracic Surgery Service on 3/27/99 and taken to the Operating Room for a video assisted thorascopic right lower lobe lobectomy by Dr. Minick. Postoperatively, the patient did well, with no complications, and was followed by the Internal Medicine Service. The patient went into rapid atrial fibrillation postoperatively, and was successfully converted into a normal sinus rhythm using Diltiazem IV, which was converted to p.o. Diltiazem. The patient's postoperative course was largely unremarkable but for dysrhythmia, and the patient's pain was well controlled with p.o. pain medications, Percocet. Final pathology was read as squamous cell carcinoma, 4.0 cm., moderately differentiated with focal characterization with extensive necrosis. The patient was discharged to home with medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d., Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d., Dyazide 25 mg q.d., nose spray b.i.d., calcium chloride pills q.d., Colchicine 600 mg q.d., cyproheptadine hydrochloride 4 mg b.i.d. q.h.s., anticholesterol med., Albuterol nebulizers 250 mg q.4h., Allopurinol 300 mg q.d., Colchicine 0.6 mg q.d., cyproheptadine hydrochloride by mouth 400 mg q.d., Digoxin 0.125 mg q.d., Diltiazem 30 mg t.i.d., Colace 100 mg t.i.d., Lasix 40 mg p.o. q.d., Percocet 1-2 tablets p.o. q.4h. p.r.n., Dilantin 200 mg p.o. b.i.d., and Trazodone 100 mg p.o. q.h.s., with follow-up with Thoracic Surgery Service as well as with primary care physician and Cardiology as needed.
|
Has the patient ever been on zantac
|
{
"answer_end": [
1544
],
"answer_start": [
1469
],
"text": [
"medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d.,"
]
}
|
A 83-year-old male patient with a history of CAD, IMI, CABG (2000), HTN, and BPH presented with sore throat, cough, and weakness, and was admitted to a medical service with a diagnosis of viral syndrome. He had an EKG showing A-paced at 69, IMI, normal axis, and no acute ischemic changes, a MIBI showing an EF of 45% and multiple pulmonary nodules, a CXR was negative, and a CT Chest showed several pulmonary nodules in RUL inferiorly, the largest being 0.6cm, and other tiny nodules in the upper lobes bilaterally, 2-3mm, and several small nodes in the mediastinum with no LAD. CTAB, RRR were normal. He was given TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, CEPACOL 1-2 Lozenge PO Q4H PRN Other:sore throat, Vitamin B12 (Cyanocobalamin) 1,000 mcg IM QD x 3 doses, Dipyridamole 25 mg PO QPM, Lasix (Furosemide) 10 mg PO QD, Isordil (Isosorbide Dinitrate) 30 mg PO TID, Ativan (Lorazepam) 3.5 mg PO QHS PRN Insomnia, Inderal (Propranolol HCl) 10 mg PO QID, Norvasc (Amlodipine) 2.5 mg PO QD, Nitroglycerin 0.2% Topical TP BID Instructions: 1 inch, Zetia (Ezetimibe) 10 mg PO QD, Azithromycin 500 mg pack 500 mg PO QD x 4 doses, and Calcium Phosphate, Oral, Reason for override: aware. He had no significant fever or WBC and his symptoms improved on admission with no cough. He was observed O/N with IVF and improved in the morning and will be D/C'd on Azithromycin x 5 days. For the pulmonary nodules, he will follow-up with Dr. Muether as an outpatient for w/u. For Heme, he was given anemia, iron studies, B12, and folate sent and got B12 1000ug IM x 1 and was instructed to follow-up with the doctor's office to get injections for 2 more days, then monthly, likely due to a gastrectomy. He was given instructions to continue TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, CEPACOL 1-2 Lozenge PO Q4H PRN Other:sore throat, Ativan (Lorazepam) 3.5 mg PO QHS PRN Insomnia, Azithromycin 500 mg pack 500 mg PO QD x 4 days, B12 1000ug QD for 2 more days, then qmonth, and to call his doctor if he continues to feel unwell or returns to the hospital, and to go to the doctor's office on Thursday and Friday to receive the B12 injections. He was discharged in a stable condition.
|
Has the patient had previous vitamin b12 ( cyanocobalamin )
|
{
"answer_end": [
773
],
"answer_start": [
718
],
"text": [
"Vitamin B12 (Cyanocobalamin) 1,000 mcg IM QD x 3 doses,"
]
}
|
Glen Cooperwood, a 69 year old male with ischemic CMP (EF 25-30%), recent admission for atrial flutter, s/p ablation, and NSVT, was discharged on 6/11/05 at 12:00 PM. The patient was given ACETYLSALICYLIC ACID 81 MG PO QD, INSULIN NPH HUMAN 10 UNITS SC BID, LISINOPRIL 10 MG PO QD, OXYCODONE 5-10 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for TRICOR PO (ref #76717119), POTENTIALLY SERIOUS INTERACTION: WARFARIN & FENOFIBRATE, MICRONIZED Reason for override: monitoring INR, KEFLEX (CEPHALEXIN) 250 MG PO QID X 12 doses Starting when IV ANTIBIOTICS END, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 25 MG PO QD Food/Drug Interaction Instruction, TRICOR (FENOFIBRATE) 145 MG PO QD, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, DIET: House/Low chol/low sat. fat, ACTIVITY: No heavy lifting and do not lift L elbow above L shoulder x 1 month, Follow up appointment(s) with Dr. Vuckovich on June 10:40am, ALLERGY: NKA, ADMIT DIAGNOSIS: s/p ICD, PRINCIPAL DISCHARGE DIAGNOSIS; Responsible After Study for Causing Admission) s/p ICD, OTHER DIAGNOSIS; Conditions, Infections, Complications, affecting Treatment/Stay CHF (congestive heart failure) CAD (coronary artery disease) s/p CABG (S/P cardiac bypass graft surgery) dm (diabetes mellitus) htn (hypertension) hyperchol (elevated cholesterol) cri (chronic renal dysfunction), OPERATIONS AND PROCEDURES: none, OTHER TREATMENTS/PROCEDURES (NOT IN O.R.): s/p dual chamber ICD, BRIEF RESUME OF HOSPITAL COURSE: 69 y/o man with ischemic CMP (EF 25-30%), recent admit for atrial flutter, s/p ablation, and NSVT. Primary prevention ICD placed without complication. Had short runs of AF during procedure. For coumadin, baby ASA. Also h/o HTN, DM, CRI, CHF. ADDITIONAL COMMENTS: Continue coumadin 5mg each night. Have your INR/coumadin level checked on Monday, March, DISCHARGE CONDITION: Stable, TO DO/PLAN: No dictated summary, ENTERED BY: WEALER, ROYAL R., PA-C (NY43) 6/11/05 @ 10.
|
Has the patient had previous coumadin ( warfarin sodium )
|
{
"answer_end": [
356
],
"answer_start": [
317
],
"text": [
"COUMADIN (WARFARIN SODIUM) 5 MG PO QPM,"
]
}
|
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage.
|
What types of medications have been tried for fever management
|
{
"answer_end": [
2436
],
"answer_start": [
2395
],
"text": [
"Tylenol 650 to 1000 mg PO q. 6h PRN 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.
|
has the patient had lispro
|
{
"answer_end": [
1653
],
"answer_start": [
1595
],
"text": [
"to insulin with his standing doses of Lantus with a lispro"
]
}
|
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