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Arron Umbaugh was admitted on 4/30/2001 and discharged on 7/10/2001 with a code status of full code and disposition of home w/ services. The discharge medications included ASA (Acetylsalicylic Acid) 325 mg PO QD, Atenolol 25 mg PO QD Starting Today (1/24) HOLD IF, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 60 mg PO QD Starting Today (1/24) Instructions: Take 60mg per day for 3 days and then change, Zestril (Lisinopril) 7.5 mg PO QD, on order for KCL IMMEDIATE REL. PO (ref # 85723815) POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: will follow, on order for KCL SLOW REL. PO (ref # 68279429), COUMADIN (Warfarin Sodium) 6 mg PO QD, on order for ZOCOR PO (ref # 88249805) POTENTIALLY SERIOUS INTERACTION: WARFARIN & SIMVASTATIN, ZOCOR (Simvastatin) 20 mg PO QHS, on order for ERYTHROMYCIN TP (ref # 53201344) POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & ERYTHROMYCIN, TOPICAL OR OPHTHALMIC, Metformin 1,000 mg PO BID Starting Today (1/24), Prilosec (Omeprazole) 20 mg PO QD, with instructions to take consistently with meals or on empty stomach, and a warning for a potentially serious interaction: Furosemide & Omeprazole, Valacyclovir 1,000 mg PO Q8H X 7 Days, with Tylenol. Please page Dr. Blouir about your eye pain and come to the ED, lasix qd and see Dr. boeshore on wed. as well as daily weights, and to call Dr. Pradel if they can't control their pain due to zoster on your back. The patient was admitted with CHF exacerbation, increased SOB over past few days, orthopnea and PND, with left sided failure and diastolic dysfunction, and IV lasix 40 in ED, which decreased SOB. The patient was also prescribed Metformin 1000 mg PO BID, Prilosec (Omeprazole) 20 mg PO QD, and Valacyclovir 1000 mg PO Q8H X 7 Days with instructions to take consistently with meals or on empty stomach, and a warning for a potentially serious interaction: Furosemide & Omeprazole. Override Notices were added for COUMADIN PO (ref # 29560859), KCL IMMEDIATE REL. PO (ref # 85723815), KCL SLOW REL. PO (ref # 68279429), and ZOCOR PO (ref # 88249805) due to potentially serious interactions: Aspirin & Warfarin, Lisinopril & Potassium Chloride, Warfarin & Simvastatin, respectively. The patient was also instructed to take lasix qd and see Dr. boeshore on wed. as well as daily weights, and to call Dr. Pradel if they can't control their pain due to zoster on their back. The patient was discharged with discharge medications including ASA (Acetylsalicylic Acid) 325 mg PO QD, Atenolol 25 mg PO QD Starting Today (1/24) HOLD IF, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 60 mg PO QD Starting Today (1/24) Instructions: Take 60mg per day for 3 days and then change, Zestril (Lisinopril) 7.5 mg PO QD, COUMADIN (Warfarin Sodium) 6 mg PO QD with instructions to avoid high Vitamin-K containing foods, and ZOCOR (Simvastatin) 20 mg PO QHS with instructions to avoid grapefruit unless MD instructs otherwise.
|
What is the current dose of asa ( acetylsalicylic acid )
|
{
"answer_end": [
212
],
"answer_start": [
172
],
"text": [
"ASA (Acetylsalicylic Acid) 325 mg PO QD,"
]
}
|
This 70-year-old female with CHF, coronary artery disease, diabetes, peripheral vascular disease, and chronic renal insufficiency was admitted on 0/5/06 for weakness and confusion. Her hospital course was complicated by worsening cardiac function with minimal improvement on milrinone and decreasing urine output despite diuretics and also gross gastrointestinal bleeding with melanotic stool while she was on Coumadin for atrial fibrillation. In addition, there was concern for sepsis and she was placed on antibiotics with levofloxacin, Flagyl, and vancomycin. She required a transfer to the Cardiac Care Unit on 9/15/06 for further medical therapy for poor cardiac output, a possible need for CVVH, given volume overload in the setting of renal failure, and work-up of GIB. Her code status was DNR/DNI, but was changed to comfort measures only on 1/17/06 due to a large ascending colorectal mass with ulcerations. Being CMO status, she was removed of all pressors and antibiotics and made comfortable sedated on fentanyl and Versed. She was then extubated for comfort with family present and had agonal breathing with episodes of apnea and was given additional sedation for comfort. The patient drew her last breath at 2:20 p.m. with family present and was pronounced dead at 2:20 p.m. on 1/17/06. Family declined autopsy.
|
Was the patient ever prescribed versed
|
{
"answer_end": [
1090
],
"answer_start": [
1015
],
"text": [
"fentanyl and Versed. She was then extubated for comfort with family present"
]
}
|
This 66 year old African American woman presented with an acute stroke and was brought in by her daughter. She had a CTA done which showed questionable luminal narrowing of the distal left middle cerebral artery, and was given a 9 mg bolus dose of intravenous TPA over two minutes and 81 mg given over the following hour. Her past medical history includes diet controlled diabetes, obesity, hypertension, ulcerative colitis, a prior MI in 1988, and a possible old stroke. Her medications are aspirin 325 mg and Asacol, although she was unsure of the dose. Blood pressure was 138/76, heart rate was 80 and paced, and she had a right field compromise difficulty crossing the midline with a right upper motor neuron seventh weakness and decreased power on the right side of the face. After the TPA, her language returned completely to normal. Protocol for the stroke was followed, including blood pressure monitoring, nasal oxygen, and no antiplatelet therapy for 24 hours. Head of bed was raised to 30 degrees and a head CT was repeated the following morning. An echocardiogram showed normal ventricular size and systolic function, trace aortic insufficiency, trace mitral regurgitation, and persistent atrial flutter. She was coumadinized and discharged without rehabilitation on 0/21/99 on Coumadin with a plan for complete cardioversion within one month.
|
has there been a prior oxygen
|
{
"answer_end": [
948
],
"answer_start": [
915
],
"text": [
"nasal oxygen, and no antiplatelet"
]
}
|
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.
|
When was flomax discontinued
|
{
"answer_end": [
2559
],
"answer_start": [
2529
],
"text": [
"on his Flomax until that time."
]
}
|
Mr. Quigg is a 42-year-old man with history of diabetes, end-stage renal disease on hemodialysis, left Charcot foot complicated by recurrent cellulitis who presented with left lower leg swelling, erythema, and pain. On admission, his temperature was 100.8, heart rate was 111, and blood pressure was 140/70. His left lower extremity had 1+ pitting edema with erythema on the anterior shin and foot. He was uptitrated to 5mg and also lopressor, started on Lyrica and oxycodone for breakthrough pain, and received Fentanyl PCA. His home medications included Colace 100 mg b.i.d., folate 1 mg p.o. daily, gemfibrozil 600 mg b.i.d., Lantus 30 mg subcu q.p.m., Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d., and Coumadin. His Lipitor was decreased to 20mg due to rhabdomylosis risk, and he was also started on low dose b-blocker to reduce perioperative MI risk prior to his surgery. His Vancomycin was continued given his history of MRSA cellulitis, with a goal of a level less than 20, and he was bridged with heparin with a goal PTT of 60-80. He was restarted on his Lantus and Aspart doses with meals, and his Coumadin was held prior to surgery and decreased to 20mg with a repeat lipid panel in 4-6 weeks. He required antibiotics which were discontinued at this time and he was discharged with dry sterile dressing changes to his residual limb daily, PTT goal 60-80, INR goal 2-3 until stable off of levofloxacin, monitoring of FS and adjustment of DM regimen, monitoring pain scale and decreasing pain medications as pain improves, hemodialysis M/W/F, and follow up with Dr. Carpino voice message left on his medical assistant's voice mail and Dr. Lynes 6/10/06 at 9:30am. Psychiatry service was consulted who recommended low dose Ativan prior to him going for dialysis. He was initially placed on a ketamine drip and given IV Levofloxacin and IV Flagyl to cover gram negatives and anaerobes respectively, and started on oxycontin 80mg tid with oxycodone for breakthrough pain and Lyrica for neuropathic pain. He was comfortable prior to discharge on this current regimen.
|
What medications have been previously used for the treatment of pain
|
{
"answer_end": [
1657
],
"answer_start": [
1592
],
"text": [
"decreasing pain medications as pain improves, hemodialysis M/W/F,"
]
}
|
GVERRERO , STAN O 346-21-49-8, a 74 yo woman in remission from Hodgkin's Lymphoma and s/p renal transplant( 11/12 ), was discharged to Home with the attending physician being KERSON , RODNEY S , M.D. and code status being Full code. She was prescribed FESO4 ( FERROUS SULFATE ) 300 MG PO BID, FOLATE ( FOLIC ACID ) 1 MG PO QD, SYNTHROID ( LEVOTHYROXINE SODIUM ) 100 MCG PO QD, PREDNISONE 5 MG PO QAM, ZOCOR ( SIMVASTATIN ) 20 MG PO QHS, NEORAL ( CYCLOSPORINE MICRO ( NEORAL ) ) 100 MG PO BID, LOSARTAN 50 MG PO QD, ATENOLOL 25 MG PO QD, PRILOSEC ( OMEPRAZOLE ) 20 MG PO QD, AMIODARONE 400 MG PO BID, ECASA ( ASPIRIN ENTERIC COATED ) 325 MG PO QD, FLAGYL ( METRONIDAZOLE ) 500 MG PO TID X 2 Days, LEVOFLOXACIN 500 MG PO QD X 2 Days, and DIET: House / Low chol/low sat. fat with instructions for regular exercise and follow up with Dr. Schultheiss ( cardiology ) 5/30/03 scheduled. On order for NEORAL PO ( ref # 55336954 ) with a POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & CYCLOSPORINE override added on 11/0/03 by LIU , HERMAN ANTONIO , M.D., and LOSARTAN PO ( ref # 04133525 ) with a POTENTIALLY SERIOUS INTERACTION: CYCLOSPORINE & LOSARTAN POTASSIUM override added on 11/0/03 by ELVEY , EDMUND LENNY , M.D., Alert overridden: Override added on 5/27/03 by : POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & AMIODARONE HCL Reason for override: aware and POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & LEVOFLOXACIN Reason for override: aware. The patient had a hypoxic episode and EKG changes resolved, requiring 2u PRBCs, and was initially treated with lopressor 5mg IV, eventually rate controlled with dilt drip. PFT's , LFT's and TFT's were completed prior to discharge, and she was instructed to restart ecasa 5d p colonoscopy, as well as to take levofloxacin and flagyl for 5 days, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. Consider anticoagulation for PAF was recommended. On 1/16 she had Afib with RVR to 130s with chest arm pain which is her anginal equivalent. ECG with rate related ischemia ST depression V5-6, L. +Minimal troponin leak to 0.19, which subseq downtrended with nl CK. She was init treated with lopressor 5mg IV but had hypotension to 80's which resolved quickly with IVF. She was eventually rate controlled with dilt drip. She returned to sinus rhythm within the day. Cards c/s'd and recommended amio load. CXR showed no infiltrate/opacity. Levo/Flagyl given empirically x 5days though she remained afeb. Abdominal exam was concerning for focal peritoneal irritation. Her exam improved, and she was tolerating PO well at the time of discharge. She has been afeb and well appearing for several days prior to d/c. Plan to complete 5d abx. As per Dr. Thorburn her colonoscopy was complex, and she had polypectomy of 2.5 cm polyp. Path is pending. If + for cancer, the base looked "clean", so may be feasible to re-scope her for surveillance at a later time, as per GI. Hct after colonoscopy went to 24 ( baseline 30 ); post-transfusion HCt of 30.
|
Why was anticoagulation prescribed
|
{
"answer_end": [
1736
],
"answer_start": [
1683
],
"text": [
"she was instructed to restart ecasa 5d p colonoscopy,"
]
}
|
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.
|
Was the patient ever prescribed tylenol ( acetaminophen )
|
{
"answer_end": [
416
],
"answer_start": [
359
],
"text": [
"Tylenol (Acetaminophen) 500 mg PO Q6H PRN Pain, Headache,"
]
}
|
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 was the dosage prescribed 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 is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic.
|
Has this patient ever been on vitamin b12.
|
{
"answer_end": [
1015
],
"answer_start": [
969
],
"text": [
"Vitamin B12 subcutaneous injections at clinic,"
]
}
|
This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160
|
Has this patient ever been on flomax (tamsulosin)
|
{
"answer_end": [
2143
],
"answer_start": [
2110
],
"text": [
"Flomax (Tamsulosin) 0.4 mg PO QD,"
]
}
|
The patient is an elderly woman with known coronary artery disease status post coronary artery bypass graft who had her Beta blocker, Pendalol decreased from 5 mg to 2.5 mg prior to this trip to Glension Street. On return to the hospital she developed substernal chest pain that radiated down both arms, which was treated with Amoxicillin given to her by her son who is a physician. At this visit, he did start her on Prinivil and she took a sublingual nitroglycerin that completely relieved her symptoms. Laboratory studies were significant for a white blood cell count of 5.46, hematocrit 40.1, platelets 190, Cardiac Troponin I was 0.0, CK was 102, and Urinalysis was negative. Chest x-ray was clear with no infiltrates, and EKG was normal sinus rhythm with normal intervals and normal axis with a left bundle branch block pattern and first degree atrioventricular block with no change compared to an EKG done on January, 1997. MEDICATIONS ON ADMISSION: 1) Zocor 5 mg p.o. q.h.s., 2) Prinivil 5 mg p.o. q. day., 3) Pendalol 2.5 mg p.o. q. day., 4) Aspirin 325 mg p.o. q. day., 5) Synthroid 0.100 mg p.o. q. Monday, Wednesday and Friday and 0.12 mg p.o. Tuesday, Thursday, Saturday and Sunday., 6) Pepcid p.r.n. From here, she was managed medically with increases in her ACE inhibitor, Statin and the addition of nitrates. After the cardiac catheterization, she developed a large right groin hematoma at the puncture site and a bruit was noted. An ultrasound was done that revealed a pseudoaneurysm of the common femoral artery, which was later surgically repaired. MEDICATIONS ON DISCHARGE: 1) Aspirin 325 mg p.o. q. day., 2) Colace 100 mg p.o. b.i.d., 3) Synthroid 100 mcg p.o. q. Monday, Wednesday and Friday, 112 mcg p.o. q. Tuesday, Thursday, Saturday and Sunday., 4) Lisinopril 10 mg p.o. q. day., 5) Beclomethasone diproprionate double strength spray to each nostril b.i.d., 6) Zocor 20 mg p.o. q.h.s., 7) Toprol XL 75 mg p.o. q. day., 8) Imdur 30 mg p.o. q. day., 9) Augmentin one tablet p.o. q. day for seven additional days. The patient had been having low grade fevers and a cough productive of a green sputum, and experienced diaphoretic episodes, both at rest and exertion, which was relieved by a sublingual nitroglycerin. The latest echocardiogram in May of 1997 showed an ejection fraction of 35% with mid to distal septal and apical akinesis and inferior akinesis with mild mitral regurgitation, and she went 4 minutes and 18 seconds on an exercise tolerance test with Thallium which showed only fixed defects, no reversible defects.
|
Has the patient taken medication for low grade fevers
|
{
"answer_end": [
382
],
"answer_start": [
304
],
"text": [
"which was treated with Amoxicillin given to her by her son who is a physician."
]
}
|
Mr. Gerache is a 59 yo man with poorly controlled diabetes and asthma who presented with chest pain. He had intermittent chest pain with activity lasting 5 minutes, relieved with rest, as well as shortness of breath when climbing stairs. Cardiac catheterization showed LAD prox 40%, no LCX lesions, no RCA lesions, and R PDA mid 30% lesion. Beta blocker was started, cholesterol was checked (elevated triglycerides 308, total cholesterol 146, HDL 29), statin was started and aspirin was held because of the patient's stated allergy to aspirin (causing asthma type symptoms). He was started on low-dose lisinopril and no prior echo was considered as outpatient. Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient. Hemoglobin A1c is 10.7 and he will need better control of his sugars as outpatient. He has had asthma as a child and no record of PFTs but should obtain as outpatient, with home inhalers continued. Mr. Gaulding currently has good renal function but needs to have his Cr checked after starting the lisinopril. The patient was advised to consider carefully his lifestyle, including diet and exercise plans, and to take medications including VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H PRN Shortness of Breath, ATENOLOL 12.5 MG PO QD Starting IN AM (8/7), NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 60 UNITS QAM; 70 UNITS QPM SC 60 UNITS QAM 70 UNITS QPM, LISINOPRIL 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, FLOVENT (FLUTICASONE PROPIONATE) 44 MCG INH BID, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and make an appointment with his primary care doctor, take his medications as instructed, and follow up with his cardiologist within 4-6 weeks. He was also placed on a House / Low chol/low sat. fat diet, ADA 2100 cals/dy diet, 2 gram Sodium diet. He was discharged with Full code status and disposition to Home.
|
nph humulin insulin ( insulin nph human )
|
{
"answer_end": [
1394
],
"answer_start": [
1341
],
"text": [
"NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 60 UNITS QAM;"
]
}
|
Mr. Raffo is a 59-year-old male with a history of coronary artery disease status post small non-ST elevation myocardial infarction in March of 2000 and also status post cardiac catheterization with 2 vessel disease, small left PICA cerebrovascular accident, congestive heart failure with an echocardiogram in March revealing an ejection fraction of 30%, diabetes mellitus type II complicated by retinopathy, nephropathy and question neuropathy, and hypertension and hypercholesterolemia. On admission, he was on medications including Aspirin daily, Lasix 80 mg p.o. q day, Zaroxolyn 2.5 mg p.o. q day, toprol XL 50 mg p.o. q day, insulin 70/30 65/45, Actos 45 q p.m, Avapro 300 mg p.o. q day, Lipitor 10 mg p.o. q.h.s., and sublingual nitroglycerin p.r.n. For his cardiovascular issues, he was diuresed with doses of Lasix 200 mg b.i.d. IV, as well as Zaroxolyn, with a weight on admission of 135 kg and on discharge of 132 kg. A repeat echocardiogram at Ethool Hospital showed an ejection fraction of 30-35, left ventricular dimensions of 47 mm, 1 plus mitral regurgitation and global hypokinesis, as well as moderate right ventricular dysfunction. His chronic renal insufficiency is likely secondary to poor diabetic control, with a creatinine of 2.5 on March, 2001 and 3.3 at the time of admission. Acute renal failure with increasing creatinine of 6 after aggressive diuresis with a mean of 0.8 percent was treated with Dopamine started on November, 2001 to aid with renal perfusion and diuresis, which was then weaned off on August, 2001. He was discharged home with services and medications including Aspirin 325 mg p.o. q day, Lasix 80 mg p.o. q day, Zocor 20 mg p.o. q.h.s., insulin 70/30 65 units q a.m., insulin 70/30 45 units q p.m., Toprol XL 50 mg p.o. q day, Levaquin 250 mg p.o. q day for a duration of 7 days, and Actos 45 mg p.o. q p.m. He was in stable condition on discharge.
|
dopamine
|
{
"answer_end": [
1453
],
"answer_start": [
1424
],
"text": [
"Dopamine started on November,"
]
}
|
The patient is a 37-year-old gentleman with known coronary artery disease who underwent coronary artery bypass grafting times three with bilateral internal mammary arteries and a saphenous vein graft. The patient was found to have extremely pronounced atherosclerosis of his coronary arteries and had an entirely smooth postoperative course. He was maintained on low molecular weight Dextran for 48 hours for his endarterectomy and was started on enteric coated aspirin on the first day of his operation. The patient diuresed very well and was started on beta blockers. On discharge, the patient's medications included Tenormin, 75 mg po q day; enteric coated aspirin, one po q day; Carafate, 1 gram po q.i.d.; iron sulfate, 325 mg po q day; Percocet and Colace.
|
has there been a prior tenormin
|
{
"answer_end": [
644
],
"answer_start": [
584
],
"text": [
"the patient's medications included Tenormin, 75 mg po q day;"
]
}
|
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.
|
Why is the patient taking tylenol ( acetaminophen )
|
{
"answer_end": [
416
],
"answer_start": [
359
],
"text": [
"Tylenol (Acetaminophen) 500 mg PO Q6H PRN Pain, Headache,"
]
}
|
Cristopher Ottilige is a 53 year old woman with a history of diabetes mellitus who presented with abdominal pain and fevers over two weeks duration. On admission, the patient was treated with Lasix 60 mg q day, Glyburide 5 mg q day, Labetalol 200 mg b.i.d., Flagyl 500 mg p.o. q 8 hours, Levofloxacin 500 mg p.o. q 24 hours, Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day. Physical examination revealed Cervical motion tenderness and Neurologic examination found the patient alert and oriented. Abdominal CT was notable for a 7 x 8 cm low density fluid collection in the region of the right adnexa and a 4 x 8 cm low density fluid collection in the left adnexa. The patient was initially managed on triple antibiotics, ampicillin, gentamicin, and Clindamycin for empiric antimicrobial coverage, with gentamicin eventually being switched to Levofloxacin. Neurologic symptoms of abdominal pain were initially managed with Demerol and Vistaril, and by discharge the patient was without pain and afebrile. The patient was discharged on b.i.d. Flagyl 500 mg p.o. q 8 hours, Levofloxacin 500 mg p.o. q 24 hours, Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day, with instructions to call the primary care physician for fevers greater than 100.5, chills, nausea, vomiting, and abdominal pain. The patient was referred to the gynecology oncology service for further follow up as an outpatient.
|
Why was demerol originally prescribed
|
{
"answer_end": [
954
],
"answer_start": [
867
],
"text": [
"Neurologic symptoms of abdominal pain were initially managed with Demerol and Vistaril,"
]
}
|
This is a 66-year-old man with diabetes, hypertension, obesity and non-Hodgkin's lymphoma of the right hip on chemotherapy (R-CHOP) which began on 4/10/06 and will continue for 18 weeks, reporting no complications from ischemic chemotherapy. The patient presented to the emergency room with syncope and was hypotensive on arrival, receiving IV normal saline as volume resuscitation. The second set of cardiac enzymes was positive with a troponin of 2, and an echocardiogram the morning following admission showed a dilated right ventricle consistent with right ventricular strain. A PE protocol CT scan showed a large saddle embolus, and the patient was treated initially with IV heparin, transitioned to Coumadin and then the decision was made to try Lovenox therapy for long-term anticoagulation. Cardiac enzymes normalized and repeat echocardiogram showed mild improvement in right heart function. On admission, the patient's medications were Atenolol 50 daily, lisinopril 5 daily, Protonix 40 daily, metformin 1500 daily, Lantus 60 daily, Humalog 20 before meals, Byetta 5 mcg twice daily, levothyroxine (dose unknown), OxyContin 40 every eight hours, Percocet two tabs every 3 hours as needed for pain and gabapentin (dose unknown).
|
protonix
|
{
"answer_end": [
1067
],
"answer_start": [
985
],
"text": [
"Protonix 40 daily, metformin 1500 daily, Lantus 60 daily, Humalog 20 before meals,"
]
}
|
Ms. Lofstrom is a 57-year-old female with a past medical history of hypertension, diabetes mellitus, multinodular goiter, arthritis and questionable recurrent bouts of generalized weakness who was admitted for new onset of right sided weakness, right leg numbness and weakness, right arm clumsiness followed by dysarthria. Laboratory tests showed glucose of 353, sodium 138, potassium 4.9, chloride 98, CO2 28, BUN 33, creatinine 1.1, calcium 10.3, magnesium 2.0, troponin 0.09, white count 8.4, hematocrit 39.8, platelet count 367,000, PT 12.1, PTT 19.5, INR 1.0. An echocardiogram revealed evidence of concentric LVH with preserved systolic function, calculated ejection fraction of 55%, one plus tricuspid regurgitation and normal peak doppler flow velocity across the tricuspid valve. Carotid noninvasive studies showed no evidence of hemodynamically significant disease in either carotid artery. MRI showed a focal area of increased T2 signal in the posterior limb of the left internal capsule, close the genu and a similar smaller area of signal abnormality in the left globus pallidus adjacent to the left internal capsule abnormality. The patient had not taken her insulin for several days prior to admission, and was placed on her regular insulin schedule as well as a sliding scale with blood sugar between 150 and high 200s. Her medications included Hydrochlorothiazide 12.5 milligrams once a day, Norvasc 5 milligrams once a day, Taxol 28 milligrams once a day, Premarin 0.625 milligrams once a day, Trazodone, insulin 12 units of regular and 50 units of NPH in the morning and Ansaid 100 milligrams p.o. b.i.d. p.r.n. joint pain. She was also reportedly taking a baby aspirin 81 milligrams once a day, and was placed on subcu heparin and started on full dose aspirin 325 milligrams p.o. q.d. while her antihypertensives were held in order to maintain a systolic blood pressure between 140-160 with a diastolic blood pressure of 85-90. The patient was rehydrated with IV fluids, and close observation was paid to her electrolytes including her potassium. Rheumatology was consulted and recommended checking a urinalysis to check for red blood cells and casts, which showed no protein, no blood, 0-2 red blood cells, and no casts. He therefore suggested to continue aspirin, but in higher doses to alleviate her left shoulder pain. The patient's Norvasc continued to be held with excellent control of her blood pressure between systolic of 140-160, and should not be reinitiated until roughly ten days after her stroke. Social work was consulted due to a history of abuse by her husband, but no further abuse history was elicited since his death. The patient was considered stable and ready for discharge to a rehabilitation facility.
|
has the patient had ansaid
|
{
"answer_end": [
1642
],
"answer_start": [
1586
],
"text": [
"and Ansaid 100 milligrams p.o. b.i.d. p.r.n. joint pain."
]
}
|
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.
|
Was the patient ever prescribed lisinopril
|
{
"answer_end": [
697
],
"answer_start": [
671
],
"text": [
"LISINOPRIL 20 MG PO DAILY,"
]
}
|
Patient was admitted to the Toott Hospital surgery service after undergoing LRYGB and was transferred to the floor from the PACU in stable condition. Pain was controlled and no issues were reported overnight into POD1. The patient had an UGI on POD1 that was negative for obstruction or leak, and was started on a Stage I diet which was tolerated well. The following day the patient was started on a Stage II diet that was tolerated as well, but initially struggled to have adequate intake. The patient was started on ALBUTEROL INHALER 2 PUFF INH QID PRN Shortness of Breath, Wheezing, LANTUS (INSULIN GLARGINE) 60 UNITS SC DAILY, ROXICET ORAL SOLUTION (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain, ZANTAC SYRUP (RANITIDINE HCL SYRUP) 150 MG PO BID, ACTIGALL (URSODIOL) 300 MG PO BID, and LEVAQUIN (LEVOFLOXACIN) 500 MG PO DAILY with instructions to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose, and to cycle (hold 1 hr before to 2 hr after) if on tube feeds, and to take 2 hours before or 2 hours after dairy products. Sugars remained high in 200's during admission and patient was seen by Endocrine service and sugars finally improving with lantus 60 sc hs. The patient also had some difficulties with urination on POD4 and required a foley catheter for about a day, but was d/c'd the AM before she was discharged and urinated without incident. Patient was noted to have a UTI at discharge and was started on three day course of levaquin. The patient was discharged in stable condition, tolerating stage II diet well, ambulating, voiding independently, and with adequate pain control. The patient was given explicit instructions to follow-up in clinic with Dr. Truglia in 1-2 weeks and sent home with VNA for wound checks and close sugar control with instructions to f/u with Leland Bredeson by phone and record fingersticks, and to f/u with her PCP if she has further problems with urination. The patient was also instructed to shower but not bathe, swim or otherwise immerse her incision, not to lift anything heavier than a phone book, not to drive or drink alcohol while taking narcotic pain medication, and to resume all of her home medications, and to call her doctor or go to the nearest emergency room if she has fevers > 101.5 F, vomiting, or increased redness, swelling, or discharge from her incision.
|
What medications if any has the patient tried for pain in the past
|
{
"answer_end": [
710
],
"answer_start": [
631
],
"text": [
"ROXICET ORAL SOLUTION (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain,"
]
}
|
A 66-year-old gentleman with a medical history significant for coronary artery disease and two prior MIs presented with substernal chest pain while walking that lasted 2-3 hours and was relieved by rest and sublingual nitroglycerin. He was admitted and cardiac catheterization revealed 90% proximal LAD stenosis, 90% mid LAD and 100% distal LAD stenosis, 100% mid LVB1, 80% mid circumflex, 70% proximal D1, 70% proximal PDA, and a right dominant circulation, with diffuse coronary calcification and extensive diffuse disease with small distal vessels. LAD in stent restenosis and collateral flow diffusely small left main. On 4/15/05, the patient underwent CABG x4 with SVG1 to RCA, and sequential graft of SVG2 to D1 and then OM1, with LIMA to LAD and an LAD endarterectomy. On arrival to the hospital, he was given 150 mg of Plavix, heparin 500 units for 48 hours, and aspirin that same night. He was also started on Enteric-coated aspirin 325 mg p.o. daily, atenolol 75 mg p.o. daily, Colace 100 mg p.o. t.i.d., oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n. pain, Plavix 75 mg p.o. daily, Lantus 38 units subcutaneously at bedtime, NovoLog 18 units subcutaneous q.a.m., and Lasix with good effect. He required the transfusion of a unit of packed red blood cells and neosynephrine transiently, which was weaned off on postoperative day #2. He was also noted to have a preoperative urinary tract infection of E. coli for which he was started on levofloxacin on 0/5/05 and treated for five days. The patient was followed by the Diabetes Management Service for blood sugar control and was transitioned from IV insulin to subcutaneous insulin postoperatively. He was discharged to home in good condition on postoperative day #7 on the following medications and is to have a follow-up appointment with his cardiologist, Dr. Abusufait, in one to two weeks, and with his cardiac surgeon, Dr. Cederberg, in four to six weeks.
|
Has this patient ever been prescribed insulin
|
{
"answer_end": [
1653
],
"answer_start": [
1584
],
"text": [
"transitioned from IV insulin to subcutaneous insulin postoperatively."
]
}
|
Marcelo Walts was admitted to the medical service for a CHF exacerbation and was given ECASA (Aspirin Enteric Coated) 325 mg PO QD, Captopril 12.5 mg PO TID with a potential serious interaction with Potassium Chloride, Lasix (Furosemide) 40 mg PO TID, Levoxyl (Levothyroxine Sodium) 100 mcg PO QD, Nitroglycerin 1/150 (0.4 mg) 1 tab SL Q5 min x 3 PRN Chest Pain HOLD IF: SBP<[ ], Zocor (Simvastatin) 20 mg PO QHS with a potential serious interaction with Niacin, Vit. B-3, Plavix (Clopidogrel) 75 mg PO QD, Atenolol 25 mg PO QD, Nitropatch (Nitroglycerin Patch) 0.2 mg/hr TP QHS, Glyburide 5 mg PO BID, Isordil (Isosorbide Dinitrate) 10 mg PO BID, and a diet of House/Low Chol/Low Sat. Fat and 4 gram Sodium. Activity was limited to Walking as tolerated, and the patient was also given instructions to give ECASA on an empty stomach, and to avoid grapefruit with Zocor unless instructed otherwise. Upon discharge, the patient was given a Full Code status and was sent Home with a follow up appointment with Sandler on 11/28/02. The patient also underwent cardiac catheterization and stent placement of RCA with the medications Heparin, ASA, Plavix, Metoprolol, nitrates, ACE-I, statin, lasix, and nebs for wheezing, and was monitored for lytes. Upon discharge, the patient was stable and advised to follow up with Dr. Lidstone and Dr. Darlin for post-cath management and overall management of CHF and flash pulmonary edema.
|
Is the patient currently or have they ever taken glyburide
|
{
"answer_end": [
602
],
"answer_start": [
580
],
"text": [
"Glyburide 5 mg PO BID,"
]
}
|
Mr. Neilsen is a 59-year-old morbidly obese man with a history of morbid obesity, paroxysmal atrial fibrillation, ejection fraction of 40 percent, obstructive sleep apnea on continuous positive airway pressure, history of cellulitis, and presenting with progressive lower extremity weakness bilaterally and urinary incontinence. On admission, EMG showed decreased recruitment in the tibialis anterior and gastrocnemius bilaterally, and he was treated with seven days of Bactrim for resolution of his incontinence and he was not anticoagulated at the moment though Coumadin should be a consideration given his risk of stroke. Two weeks prior to admission he noted some lumbar and sacral pain, nonradiating, worse while moving his right leg, and increasing urinary frequency without burning or urinary incontinence. On the night of admission, while getting up from a chair, his right leg gave out and he fell to the floor without injury or head trauma. His laboratory data on admission showed sodium 140, potassium 4.5, chloride 102, bicarbonate 26, BUN 20, creatinine 0.9, glucose 101, white blood cell count of 9 with 76 polys, 4 bands, hematocrit 37.6 and platelet count of 236, and urinalysis showed 3+ blood and positive leukocyte esterase with 15-20 white blood cells, one plus bacteria and one plus squamous cells. He was started on a trial of Lasix p.o. q day to decrease his peripheral edema to help him with rehabilitation, and he was instructed to apply Nystatin powder for his pannus rash. His medications on discharge included Aspirin 325 mg p.o. q day, Colace 100 mg p.o. b.i.d., Lasix 40 mg p.o. q a.m., Indomethacin 25 mg p.o. t.i.d. p.r.n. pain, Lisinopril 15 mg p.o. q day, multivitamin one tablet p.o. q day, Bactrim DS one tablet p.o. t.i.d., Tamsulosin 0.4 mg p.o. q day, and Miconazole 2% topical powder b.i.d., and he was discharged to rehabilitation care for leg strengthening in a stable condition.
|
What was the indication for my patient's bactrim
|
{
"answer_end": [
512
],
"answer_start": [
436
],
"text": [
"he was treated with seven days of Bactrim for resolution of his incontinence"
]
}
|
A 57-year-old female with macromastia and abdominal skin laxity s/p massive weight loss 2/2 gastric bypass was admitted to plastic surgery on 5/8/07. On admission, the patient was prescribed 1. ACETAMINOPHEN 1000 MG PO Q6H, 2. LEVOTHYROXINE SODIUM 75 MCG PO QD, 3. QUINAPRIL 20 MG PO QAM, 4. RANITIDINE HCL 150 MG PO QD, 5. MULTIVITAMINS 1 CAPSULE PO QD, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, VITAMIN C ( ASCORBIC ACID ) 500 MG PO BID, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, KEFLEX ( CEPHALEXIN ) 500 MG PO QID, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, PEPCID ( FAMOTIDINE ) 20 MG PO BID, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain (ref #901341233), on order for DILAUDID PO 2-4 MG Q3H (ref #901341233), INSULIN REGULAR HUMAN, supplemental (sliding scale) insulin, If receiving standing regular insulin, please give at same, SYNTHROID ( LEVOTHYROXINE SODIUM ) 75 MCG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ), REGLAN ( METOCLOPRAMIDE HCL ) 10 MG IV Q6H PRN Nausea, ZOFRAN ( POST-OP N/V ) ( ONDANSETRON HCL ( POST-... ), on order for KCL IV (ref #964491549), POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM, SIMETHICONE 80 MG PO QID PRN Upset Stomach, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, TIGAN ( TRIMETHOBENZAMIDE HCL ) 200 MG PR Q6H PRN Nausea, ibuprfen. Do not drink/drive/operate machinery with pain medications., Take a stool softener to prevent constipation., 4. Continue your antibiotics as long as you have a drain in place., Sliding Scale (subcutaneously) SC AC+HS Medium Scale, If BS is 125-150, then give 0 units subcutaneously, 30 MILLILITERS PO DAILY PRN Constipation, 1 MG IV Q6H X 2 doses PRN Nausea, Number of Doses Required (approximate): 10, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain. The patient tolerated all procedures without difficulty and post-op period was uneventful, and at discharge, the patient was afebrile with stable vitals, taking po's/voiding q shift, ambulating independently and pain was well-managed with Tigan (Trimethobenzamide HCl) 200 mg PR Q6H PRN Nausea, Tigan (Trimethobenzamide HCl) 300 mg PO Q6H PRN Nausea, Simethicone 80 mg PO QID PRN Upset Stomach, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, 1 mg IV Q6H x 2 doses PRN Nausea, 30 Milliliters PO Daily PRN Constipation and TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, DULCOLAX (Bisacody
|
Has the patient ever had milk of magnesia ( magnesium hydroxide )
|
{
"answer_end": [
1020
],
"answer_start": [
979
],
"text": [
"MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ),"
]
}
|
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 pt. ever been on lantus insulin ( glargine ) before
|
{
"answer_end": [
1813
],
"answer_start": [
1758
],
"text": [
"Lantus insulin (Glargine) 40 units subcutaneous q.a.m.,"
]
}
|
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.
|
How much atorvastatin does the patient take per day
|
{
"answer_end": [
722
],
"answer_start": [
672
],
"text": [
"atorvastatin 20 mg daily, Neurontin 100 mg t.i.d.,"
]
}
|
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->
|
What treatments has patient been on for trace edema; in the past
|
{
"answer_end": [
1392
],
"answer_start": [
1326
],
"text": [
"continue lasix, 60 bid (was 40po TID at start of hospitalization),"
]
}
|
This 54 year old gentleman presented to the Wickpro Conch Medical Center with an infected left lower leg pressure ulcer with open and gangrenous muscle exposed through the posterior wound. His past medical history is significant for insulin dependent diabetes mellitus, peripheral vascular disease, coronary artery disease, congestive heart failure, history of atrial fibrillation/flutter, and right sacroiliac joint decubitus ulcer. His physical examination revealed mottled distal extremities, bilateral inspiratory wheezes, and a positive bowel sound. The patient underwent a four vessel coronary artery bypass graft on 6/17/95 and left lower extremity fasciotomy on 11/27/95 and was taken to the Operating Room on 7/25/95 for a preoperative diagnosis of a left lower extremity infected pressure sore. Intraoperatively, the patient was noted to have necrosis of both heads of the gastrocnemius muscle and copious amounts of antibiotic-containing solution was used to irrigate the wound, for which he was started on Ampicillin, Gentamicin, and Flagyl empirically until culture results returned and was taken back on 2/29/95 for a second irrigation and debridement procedure. The patient was placed on Klonopin 1 mg po tid, Tylenol 650 mg p.o. q4h p.r.n. headache, Aspirin 81 mg p.o. qd, Albuterol nebulizer 0.5 cc in 2.5 cc of normal saline q.i.d., Capoten 25 mg p.o. qh, Chloral hydrate 500 mg p.o. q.h.s. p.r.n. insomnia, Clonopin 1 mg p.o. t.i.d., Digoxin 0.375 mg p.o. qd, Colace 100 mg p.o. b.i.d., Insulin NPH 38 units subcu b.i.d., Milk of Magnesia 30 cc p.o. qd p.r.n. constipation, Multivitamins one capsule p.o. qd, Mycostatin 5 cc p.o. q.i.d., Percocet one or two tabs p.o. q3-4h p.r.n. pain, Metamucil one packet p.o. qd, Azmacort six puffs inhaled b.i.d., Axid 150 mg p.o. b.i.d., Ofloxacin 200 mg p.o. b.i.d. x 7 days, and Insulin NPH 38 units in the morning and 38 units at night. The patient was initially ruled out for a myocardial infarction following his first operative procedure and had no episodes of hypotension. He was switched over from Gentamicin to Ofloxacin to continue his antibiotic course and has been followed by the Infectious Disease service, receiving 7 more days of po Ofloxacin as an outpatient. The patient's medications upon discharge include Aspirin 81 mg po qd, Digoxin 0.325 mg po qd, Azmacort 6 puffs inhaled bid, Heparin 5000 units subcu bid, Zantac 150 mg po bid, Lasix 40 mg po qd, Capoten 25 mg q 8, Albuterol nebulizers 0.5 cc in 2.5 cc normal saline qid, NPH insulin 38 units subcu bid, Nystatin swish and swallow 5 cc po qid, Bactrim DS one tab po bid, Tylenol 650 mg po q4h prn headache, Chloral hydrate 500 mg po qhs prn insomnia, Clonopin 1 mg po tid, Colace 100 mg po bid, Milk of Magnesia 30 cc po qd prn constipation, Multivitamins one capsule po qd, Mycostatin 5 cc po qid, Percocet one or two tabs po q3-4h prn pain, Metamucil one packet po qd, Azmacort six puffs inhaled bid, Axid 150 mg po bid, and Ofloxacin 200 mg po bid x 7 days.
|
has there been a prior tylenol
|
{
"answer_end": [
1265
],
"answer_start": [
1225
],
"text": [
"Tylenol 650 mg p.o. q4h p.r.n. headache,"
]
}
|
Mr. Quigg is a 42-year-old man with history of diabetes, end-stage renal disease on hemodialysis, left Charcot foot complicated by recurrent cellulitis who presented with left lower leg swelling, erythema, and pain. On admission, his temperature was 100.8, heart rate was 111, and blood pressure was 140/70. His left lower extremity had 1+ pitting edema with erythema on the anterior shin and foot. He was uptitrated to 5mg and also lopressor, started on Lyrica and oxycodone for breakthrough pain, and received Fentanyl PCA. His home medications included Colace 100 mg b.i.d., folate 1 mg p.o. daily, gemfibrozil 600 mg b.i.d., Lantus 30 mg subcu q.p.m., Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d., and Coumadin. His Lipitor was decreased to 20mg due to rhabdomylosis risk, and he was also started on low dose b-blocker to reduce perioperative MI risk prior to his surgery. His Vancomycin was continued given his history of MRSA cellulitis, with a goal of a level less than 20, and he was bridged with heparin with a goal PTT of 60-80. He was restarted on his Lantus and Aspart doses with meals, and his Coumadin was held prior to surgery and decreased to 20mg with a repeat lipid panel in 4-6 weeks. He required antibiotics which were discontinued at this time and he was discharged with dry sterile dressing changes to his residual limb daily, PTT goal 60-80, INR goal 2-3 until stable off of levofloxacin, monitoring of FS and adjustment of DM regimen, monitoring pain scale and decreasing pain medications as pain improves, hemodialysis M/W/F, and follow up with Dr. Carpino voice message left on his medical assistant's voice mail and Dr. Lynes 6/10/06 at 9:30am. Psychiatry service was consulted who recommended low dose Ativan prior to him going for dialysis. He was initially placed on a ketamine drip and given IV Levofloxacin and IV Flagyl to cover gram negatives and anaerobes respectively, and started on oxycontin 80mg tid with oxycodone for breakthrough pain and Lyrica for neuropathic pain. He was comfortable prior to discharge on this current regimen.
|
Has this patient ever been on flagyl
|
{
"answer_end": [
2011
],
"answer_start": [
1950
],
"text": [
"IV Flagyl to cover gram negatives and anaerobes respectively,"
]
}
|
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.
|
zestril
|
{
"answer_end": [
627
],
"answer_start": [
604
],
"text": [
"glyburide 5 mg PO q.d.,"
]
}
|
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation.
|
What medications has the patient ever tried for radioiodine ablation. prevention
|
{
"answer_end": [
2206
],
"answer_start": [
2082
],
"text": [
"She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation."
]
}
|
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 patient ever been prescribed augmentin
|
{
"answer_end": [
999
],
"answer_start": [
948
],
"text": [
"Augmentin 875/125 mg b.i.d. for a total of 10 days,"
]
}
|
A 45-year-old male with morbid obesity presented with chest pain and hypertensive urgency. He was ruled out for MI with negative serial enzymes and EKGs and a cardiac PET showed 2 small areas of reversible ischemia in the mid PDA and distal LAD territory. For CV treatment, he was given Aspirin 81mg PO daily, beta blocker, and HCTZ 25mg PO daily and Atenolol 50mg PO daily for HTN control. For Pulmonary issues, he had very mild asthma exacerbation and a restrictive ventilatory defect from obesity and was given Advair 500/50 BID, Albuterol Nebulizer 2.5 mg neb q2h, Albuterol Inhaler 2 puff inh qid PRN Shortness of Breath and prednisone 60mg QD x 3 doses. For GI issues, he had trace guaiac+ stool and a viral gastroenteritis causing diarrhea and some nausea. For endocrine issues, his A1C was 7.4 and he was educated on low sugar, low carbohydrate diet. For prevention, he was given Lovenox BID. Additional comments included taking HCTZ 25mg daily and Atenolol 50mg daily for blood pressure, eating a low sugar, low carbohydrate diet, and follow-up with cardiology on 11/0. He was discharged in a stable condition with a recommendation for monitor blood sugars and A1C, outpatient colonoscopy, and consider statin therapy, as well as Fluticasone Propionate/Salmeterol 250/50 1 puff inh BID, Albuterol Inhaler 2 puff inh QID, Artificial Tears 2 drop OD TID, Loratadine 10 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Albuterol Nebulizer 2.5 mg neb q4h, Acetylsalicylic Acid 81 mg PO daily, and Miconazole Nitrate 2% powder topical TP daily.
|
Why has the patient been prescribed albuterol nebulizer
|
{
"answer_end": [
625
],
"answer_start": [
569
],
"text": [
"Albuterol Inhaler 2 puff inh qid PRN Shortness of Breath"
]
}
|
A 79-year-old male with history of non-insulin dependent diabetes, coronary artery disease, congestive heart failure, hypertension, chronic renal failure, and left toe amputation on 7/1/06 was admitted for debridement and antibiotics. An MRA on 10/3/06 demonstrated on the right a multifocal high-grade stenosis of the proximal, anterior tibial, the tibioperoneal trunk and the proximal, posterior tibial arteries and included peroneal artery at the midcalf, two-vessel runoff and on the left diffuse high-grade stenoses of the anterior tibial, posterior tibial arteries and occlusion of the peroneal artery in the dorsalis pedis. The patient presented with bleeding from the site of the left toe amputation beginning two weeks ago associated with throbbing pain, soreness, erythema and swelling and exacerbated blood pressure when walking and only treated by narcotics. Neuro and Psych: The patient has delirium postoperatively for which he was placed on soft restraints and received Zyprexa. Cardiac: Upon admission, potassium was noted to be elevated and the patient had EKG changes associated with hyperkalemia and received Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin for coronary artery disease related event prophylaxis. Blood pressure was controlled with isosorbide dinitrate, Norvasc, lisinopril, and Lopressor. Pulmonary: No events. Maintained oxygen saturation greater than 90% on room air. Renal: Creatinine was stable in the mid 3s and trended down to 2.6 at the time of discharge below his baseline of 4-5. Voiding without difficulty at the time of discharge. Maintained on his renal medications. FEN/GI: Tolerated regular diet. Lactulose and Colace to prevent constipation while taking narcotics, also had Dulcolax p.r.n. Zinc and Vitamin C was started per the Nutrition consult. Hematology: He received heparin for DVT prophylaxis. His hematocrit remained stable. He had some oozing from the right thigh but this resolved with a pressure dressing. ID: He was treated throughout his hospitalization with vancomycin, levofloxacin and Flagyl for methicillin-resistant Staphylococcus aureus that grew from the wound after the first and second irrigation and debridement. The levofloxacin and Flagyl were discontinued prior to discharge. He will continue his vancomycin at the time of discharge. Endocrine: Diabetes controlled. He was maintained on his Prandin and insulin sliding scale for glycemic control. He also received Vitamin D, Calcitriol, Nephrocaps, Epogen, and Aranesp. His incision remained clean, dry and intact without erythema or exudate. He was afebrile with stable signs at the time of discharge. ACTIVITY INSTRUCTIONS: He is nonweightbearing on the left lower extremity to protect the open toe. COMPLICATIONS: None. DISCHARGE LABS: Laboratory tests at the time of discharge include sodium 138, potassium 4.1, chloride 111, bicarbonate 21, BUN 35, creatinine 2.6, calcium 9.0, magnesium 1.9, vancomycin 19.5, white blood cell count 7.3, hemoglobin 9.9, hematocrit 30.2, platelets 221. DISCHARGE MEDICATIONS: His medications at discharge include aspirin 325 mg p.o. daily, vitamin C 500 mg p.o. b.i.d., calcitriol 0.5 mcg p.o. daily, Colace 100 mg p.o. daily, heparin 5000 units subcutaneous t.i.d., isosorbide dinitrate 10 mg p.o. t.i.d., lactulose 30 mL p.o. t.i.d., lisinopril 50 mg p.o. daily, Lopressor 50 mg p.o. q.6h., Prandin 0.5 mg p.o. with each meal, Aranesp 40 mcg subcutaneous every week, sliding scale insulin, insulin aspart 4 units, Tylenol p.r.n., Dilaudid 2-4 mg p.o. q.4h. as needed for pain, milk of magnesia as needed for constipation, Reglan for nausea, oxycodone for pain 5-10 mg p.o. q.4h. hours
|
What medications has the patient ever tried for pain prevention
|
{
"answer_end": [
3554
],
"answer_start": [
3492
],
"text": [
"Tylenol p.r.n., Dilaudid 2-4 mg p.o. q.4h. as needed for pain,"
]
}
|
The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg
|
What types of medications have been tried for wheezing management
|
{
"answer_end": [
2333
],
"answer_start": [
2274
],
"text": [
"temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg"
]
}
|
This 81-year-old Italian-speaking gentleman was admitted to M Valley Medical Center with rising chest pain. Upon admission, his vital signs were normal and his physical examination was unremarkable. Cardiac catheterization revealed 30% mid RCA occlusion, 40% distal RCA, 90% ostial OM1, 90% mid CX, 80% proximal LAD, 99% mid LAD and 60% mid LM. EKG showed normal sinus rhythm and an incomplete right bundle-branch block. During his hospital stay, he was started on beta-blockers, statins, fluid resuscitation and vasopressor administration, subcu insulin, prednisone, Plavix, and antibiotics. He experienced agitation and delirium, for which he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n. Later during the hospital stay, he became hypotensive, requiring Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. He was also on Lopressor 25 orally every 6 hours, Diltiazem 125 mg orally daily, Furosemide 20 mg orally daily, Methylprednisolone 30 mg IV every 8 hours, Atorvastatin 80 mg orally daily, Allopurinol 100 mg orally daily, Ativan 0.5 mg orally at bedtime, Nexium 20 mg orally daily, and Proscar 5 mg orally every night. Tight glycemic control was maintained with Portland protocol in the immediate postop period and subsequently with subcu insulin. Incidental radiologic finding of a renal mass consistent with renal cell carcinoma was also found. Support for the patient's family was provided throughout the hospital course, and the patient was discharged with Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, Nexium 20 mg everyday, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath.
|
Is the patient currently or have they ever taken alcohol
|
{
"answer_end": [
727
],
"answer_start": [
642
],
"text": [
"he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n."
]
}
|
The patient is a 71-year-old male with a history of nonischemic dilated cardiomyopathy, diabetes, obstructive sleep apnea, obesity hypoventilation syndrome, and atrial flutter status post ablation. He presented with shortness of breath and a witnessed apneic episode with loss of consciousness and cyanosis. In the Centsshealt Careman Inerist Medical Center Emergency Department, he was found to be saturating 91% on room air and 99% on a nonrebreather with a pH of 7.31 and a PCO2 of 55; he was tried on BiPAP without improvement in either PCO2 or PO2. He was admitted to the CCU with CHF/apnea/sinus arrest and had a history of having stopped his Lasix dose one week prior. He was initially treated with x1 , Solu-Medrol , and DuoNebs in the ED, and ultimately treated with diuresis and a pacemaker placement. On admission, he was maintained on captopril, which was up titrated to 25 mg t.i.d. (held at one point due to the rise in the creatinine), titrated up on metoprolol to 25 mg b.i.d., antibiotics, Allopurinol 100 mg p.o. daily, Iron, Lisinopril, Toprol-XL, Coumadin (discontinued on 2/4/05), Albuterol inhaler p.r.n., Aspirin, Flomax, Hytrin, Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Flomax 0.4 mg p.o. daily, Nexium 20 mg p.o. daily, Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05, Lasix 40 mg p.o. daily, and Regular Insulin sliding scale subcutaneous q.a.c. He was followed by the Electrophysiology Service and had sinus arrest of 8-9 seconds in the setting of apnea in the CCU, and 4 seconds in the setting of apnea on the floor. He underwent pacemaker placement through cephalic veins, and was started on antibiotics following his pacemaker placement, which included cefazolin while in-house, followed by Keflex, and he was expected to stay on Keflex for four days. He was discharged with medications including Albuterol inhaler two puffs inhaled q.i.d. p.r.n. wheezing, Allopurinol 100 mg p.o. daily, Captopril 25 mg p.o. t.i.d., Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Lasix 40 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Regular Insulin sliding scale subcutaneous q.a.c., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05., Flomax 0.4 mg p.o. daily, and Nexium 20 mg p.o. daily.
|
has there been a prior allopurinol
|
{
"answer_end": [
1037
],
"answer_start": [
1007
],
"text": [
"Allopurinol 100 mg p.o. daily,"
]
}
|
Patient SAMU, CURTIS 759-74-53-9 is a 61-year-old female with multiple medical problems including dilated CMP, s/p chemo and XRT for Breast CA, CAD, s/p MI, COPD, and occasional O2 use. On admission, her VS are T97.8, HR73, BP113/71, RR18, and O2Sat 92%. She presents with dry cough associated with SOB x 2 days and increased DOE after 1/2 block, orthopnea and PND, chronic abd pain, increased Alk Phos, increased bloating, and wheezing without increased O2 need at night. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #29937145) with POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, DIGOXIN 0.125 MG PO QD, on order for LEVOTHYROXINE SODIUM PO (ref #13700176) with POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, COLACE (DOCUSATE SODIUM) 100 MG PO BID, FERROUS SULFATE 325 MG PO BID, MOTRIN (IBUPROFEN) 600 MG PO Q8H Starting Today (10/7) with PRN Pain Food/Drug Interaction Instruction Take with food, REGLAN (METOCLOPRAMIDE HCL) 5 MG PO AC, SIMETHICONE 80 MG PO QID, VITAMIN B1 (THIAMINE HCL) 100 MG PO QD, TRAZODONE 50 MG PO HS, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & WARFARIN, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: aware, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, GABAPENTIN 200 MG PO QD, TORSEMIDE 100 MG PO BID, COZAAR (LOSARTAN) 50 MG PO QD, LEVOCARNITINE 1 GM PO QD Starting Today (8/21), CITALOPRAM 20 MG PO QD, ADVAIR DISKUS 250/50 (FLUTICASONE PROPIONATE/...) 1 PUFF INH BID, NEXIUM (ESOMEPRAZOLE) 20 MG PO QD, LANTUS (INSULIN GLARGINE) 60 UNITS SC QHS, NOVOLOG (INSULIN ASPART), LIPITOR (ATORVASTATIN) 10 MG PO QPM, ATORVASTATIN CALCIUM, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and Sliding Scale (subcutaneously) SC AC with Food/Drug Interaction Instructions to Avoid milk and antacid, Take with food, Take consistently with meals or on empty stomach, and If BS is less than 125, then give 0 units subcutaneously. The patient was placed on order for COUMADIN PO (ref #29937145) and Adriamycin induced CMP HTN IDDM Sarcoid for DVT on 0/29 (goal 2-3). She was placed on po levofloxacin for 7 days and symptoms resolved. Her weight was 227lbs 7/6/05 (dry weight ~200), and she was on torsemide 100mg bid at baseline, with po lasix increased to 200bid x 2 doses, and zaroxyln 5mg po BID x 6 doses added. Tests included ALK Phos: 627, ALT: 71, AST: 65, Card Enzymes: neg, WBC: 6.4, UA: 1.011, 1+prot, 5-10WBC, 2+bact, CXR: LLL opacity, seen best on lateral view, EKG: prolonged PR, q in AVL, flat Ts laterally, unchanged from 9/5, RUQ US: sludge, gall bladder wall thickened 8mm, neg sonographic Murphy's sign, 2/4 Echo
|
Has this patient ever been prescribed vitamin b1 ( thiamine hcl )
|
{
"answer_end": [
1059
],
"answer_start": [
1020
],
"text": [
"VITAMIN B1 (THIAMINE HCL) 100 MG PO QD,"
]
}
|
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure.
|
Why is the patient on nitroglycerin
|
{
"answer_end": [
1134
],
"answer_start": [
1087
],
"text": [
"Nitroglycerin 0.4 milligrams p.r.n. chest pain,"
]
}
|
The patient is a 57 year-old woman followed by Dr. Haggard in the IWAKE HEALTHCARE Clinic for problems related to obesity, depression and poorly controlled hypertension. In March of 1995, she had a palpable indurated area at 12:00 on the right breast and was seen by Dr. Noguchi in the Surgery Clinic and scheduled for a right breast biopsy. She was admitted to the General Medical Service and given more aggressive hypertensive medications including increasing her ACE inhibitor to Lisinopril 40 mg p.o. q. day, discontinuing her Diltiazem and starting on Hydrochlorothiazide 25 mg p.o. q. daily and starting Beta blocker Lopressor 25 mg p.o. q.i.d. and increasing as tolerated according to her blood pressure. The right breast abscess was drained without incident and she was started on IV antibiotics which included Ancef 1 gram IV q. 8h. Other notable events in the hospital included a Psychiatry consult who suggested that the patient had a history of major depression and recommended ruling organic brain disease and a polysonography was done for monitoring of sleep apnea and an MMTI for further diagnostic evaluation. The patient had an uneventful postoperative course with her blood pressure remaining moderately elevated and resolution of her symptoms of right breast tenderness. On discharge, she was given Enteric coated aspirin 325 mg p.o. q. day, Colace 100 mg p.o. b.i.d., Hydrochlorothiazide 25 mg p.o. q. daily, Lisinopril 40 mg p.o. q. daily, Tylox 1-2 capsules p.o. q. 4-6h. p.r.n. pain, Atenolol 100 mg p.o. q. daily, and Cephradine 100 mg p.o. q.i.d. times five days, with follow-up in the TLET HOSPITAL Clinic with Dr. Mcgowan and in a Hmotmed Dell An Community Hospital Medical Service.
|
Has a patient had enteric coated aspirin
|
{
"answer_end": [
1360
],
"answer_start": [
1304
],
"text": [
"she was given Enteric coated aspirin 325 mg p.o. q. day,"
]
}
|
This 54 year old gentleman presented to the Wickpro Conch Medical Center with an infected left lower leg pressure ulcer with open and gangrenous muscle exposed through the posterior wound. His past medical history is significant for insulin dependent diabetes mellitus, peripheral vascular disease, coronary artery disease, congestive heart failure, history of atrial fibrillation/flutter, and right sacroiliac joint decubitus ulcer. His physical examination revealed mottled distal extremities, bilateral inspiratory wheezes, and a positive bowel sound. The patient underwent a four vessel coronary artery bypass graft on 6/17/95 and left lower extremity fasciotomy on 11/27/95 and was taken to the Operating Room on 7/25/95 for a preoperative diagnosis of a left lower extremity infected pressure sore. Intraoperatively, the patient was noted to have necrosis of both heads of the gastrocnemius muscle and copious amounts of antibiotic-containing solution was used to irrigate the wound, for which he was started on Ampicillin, Gentamicin, and Flagyl empirically until culture results returned and was taken back on 2/29/95 for a second irrigation and debridement procedure. The patient was placed on Klonopin 1 mg po tid, Tylenol 650 mg p.o. q4h p.r.n. headache, Aspirin 81 mg p.o. qd, Albuterol nebulizer 0.5 cc in 2.5 cc of normal saline q.i.d., Capoten 25 mg p.o. qh, Chloral hydrate 500 mg p.o. q.h.s. p.r.n. insomnia, Clonopin 1 mg p.o. t.i.d., Digoxin 0.375 mg p.o. qd, Colace 100 mg p.o. b.i.d., Insulin NPH 38 units subcu b.i.d., Milk of Magnesia 30 cc p.o. qd p.r.n. constipation, Multivitamins one capsule p.o. qd, Mycostatin 5 cc p.o. q.i.d., Percocet one or two tabs p.o. q3-4h p.r.n. pain, Metamucil one packet p.o. qd, Azmacort six puffs inhaled b.i.d., Axid 150 mg p.o. b.i.d., Ofloxacin 200 mg p.o. b.i.d. x 7 days, and Insulin NPH 38 units in the morning and 38 units at night. The patient was initially ruled out for a myocardial infarction following his first operative procedure and had no episodes of hypotension. He was switched over from Gentamicin to Ofloxacin to continue his antibiotic course and has been followed by the Infectious Disease service, receiving 7 more days of po Ofloxacin as an outpatient. The patient's medications upon discharge include Aspirin 81 mg po qd, Digoxin 0.325 mg po qd, Azmacort 6 puffs inhaled bid, Heparin 5000 units subcu bid, Zantac 150 mg po bid, Lasix 40 mg po qd, Capoten 25 mg q 8, Albuterol nebulizers 0.5 cc in 2.5 cc normal saline qid, NPH insulin 38 units subcu bid, Nystatin swish and swallow 5 cc po qid, Bactrim DS one tab po bid, Tylenol 650 mg po q4h prn headache, Chloral hydrate 500 mg po qhs prn insomnia, Clonopin 1 mg po tid, Colace 100 mg po bid, Milk of Magnesia 30 cc po qd prn constipation, Multivitamins one capsule po qd, Mycostatin 5 cc po qid, Percocet one or two tabs po q3-4h prn pain, Metamucil one packet po qd, Azmacort six puffs inhaled bid, Axid 150 mg po bid, and Ofloxacin 200 mg po bid x 7 days.
|
Has this patient ever been treated with zantac
|
{
"answer_end": [
2410
],
"answer_start": [
2389
],
"text": [
"Zantac 150 mg po bid,"
]
}
|
A 79-year-old male with history of non-insulin dependent diabetes, coronary artery disease, congestive heart failure, hypertension, chronic renal failure, and left toe amputation on 7/1/06 was admitted for debridement and antibiotics. An MRA on 10/3/06 demonstrated on the right a multifocal high-grade stenosis of the proximal, anterior tibial, the tibioperoneal trunk and the proximal, posterior tibial arteries and included peroneal artery at the midcalf, two-vessel runoff and on the left diffuse high-grade stenoses of the anterior tibial, posterior tibial arteries and occlusion of the peroneal artery in the dorsalis pedis. The patient presented with bleeding from the site of the left toe amputation beginning two weeks ago associated with throbbing pain, soreness, erythema and swelling and exacerbated blood pressure when walking and only treated by narcotics. Neuro and Psych: The patient has delirium postoperatively for which he was placed on soft restraints and received Zyprexa. Cardiac: Upon admission, potassium was noted to be elevated and the patient had EKG changes associated with hyperkalemia and received Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin for coronary artery disease related event prophylaxis. Blood pressure was controlled with isosorbide dinitrate, Norvasc, lisinopril, and Lopressor. Pulmonary: No events. Maintained oxygen saturation greater than 90% on room air. Renal: Creatinine was stable in the mid 3s and trended down to 2.6 at the time of discharge below his baseline of 4-5. Voiding without difficulty at the time of discharge. Maintained on his renal medications. FEN/GI: Tolerated regular diet. Lactulose and Colace to prevent constipation while taking narcotics, also had Dulcolax p.r.n. Zinc and Vitamin C was started per the Nutrition consult. Hematology: He received heparin for DVT prophylaxis. His hematocrit remained stable. He had some oozing from the right thigh but this resolved with a pressure dressing. ID: He was treated throughout his hospitalization with vancomycin, levofloxacin and Flagyl for methicillin-resistant Staphylococcus aureus that grew from the wound after the first and second irrigation and debridement. The levofloxacin and Flagyl were discontinued prior to discharge. He will continue his vancomycin at the time of discharge. Endocrine: Diabetes controlled. He was maintained on his Prandin and insulin sliding scale for glycemic control. He also received Vitamin D, Calcitriol, Nephrocaps, Epogen, and Aranesp. His incision remained clean, dry and intact without erythema or exudate. He was afebrile with stable signs at the time of discharge. ACTIVITY INSTRUCTIONS: He is nonweightbearing on the left lower extremity to protect the open toe. COMPLICATIONS: None. DISCHARGE LABS: Laboratory tests at the time of discharge include sodium 138, potassium 4.1, chloride 111, bicarbonate 21, BUN 35, creatinine 2.6, calcium 9.0, magnesium 1.9, vancomycin 19.5, white blood cell count 7.3, hemoglobin 9.9, hematocrit 30.2, platelets 221. DISCHARGE MEDICATIONS: His medications at discharge include aspirin 325 mg p.o. daily, vitamin C 500 mg p.o. b.i.d., calcitriol 0.5 mcg p.o. daily, Colace 100 mg p.o. daily, heparin 5000 units subcutaneous t.i.d., isosorbide dinitrate 10 mg p.o. t.i.d., lactulose 30 mL p.o. t.i.d., lisinopril 50 mg p.o. daily, Lopressor 50 mg p.o. q.6h., Prandin 0.5 mg p.o. with each meal, Aranesp 40 mcg subcutaneous every week, sliding scale insulin, insulin aspart 4 units, Tylenol p.r.n., Dilaudid 2-4 mg p.o. q.4h. as needed for pain, milk of magnesia as needed for constipation, Reglan for nausea, oxycodone for pain 5-10 mg p.o. q.4h. hours
|
Has the patient ever had zocor
|
{
"answer_end": [
1187
],
"answer_start": [
1128
],
"text": [
"Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin"
]
}
|
Ms. Hesby is a 36-year-old woman with very poorly controlled type 1 diabetes, end-stage renal disease, right eye blindness, lower extremity neuropathy, gastroparesis, and a history of extensive infections. She presented to Path Community Hospital with a right thigh burn and infection, and was given a prescription for antibiotics, 20 units of IV insulin, 500 mL normal saline boluses, and several 250 mL boluses, as well as 2 amps of calcium gluconate, Kayexalate, albuterol nebs, and Augmentin and IV vancomycin for her right thigh cellulitis. For long-term management, she was prescribed Lantus 24 units subcu each night, NovoLog sliding scale, PhosLo, Nephrocaps, Vitamin D, Sevelamer 1600 t.i.d., Toprol 100 mg p.o. daily, Lisinopril 5 mg p.o. daily, Plavix 75 mg p.o. daily, Keppra 500 mg p.o. b.i.d., Flovent two puffs b.i.d., Albuterol p.r.n., Baclofen 5 mg p.o. t.i.d., and Ambien 10 mg p.o. at bedtime p.r.n. The patient was admitted with a diagnosis of Diabetic Ketoacidosis (DKA) and was stabilized in the MICU on an insulin waves. She was then transitioned to NPH and finally to Lantus 24 units subcu and her hypertension is being managed on her home dose of Lopressor 25 q.i.d. and switched to Captopril, which is being titrated. Her area of cellulitis has completely resolved, and if she becomes acidotic, the patient can be managed with sodium bicarbonate and D5W in small boluses. The patient is taking her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d., however she has consistently refused her heparin. Of note, on the night of 1/26/06, the patient complained of severe cramping, right lower quadrant pain, which is new. She noted this pain has increased rapidly in the setting of diarrhea. Several C. diff studies, which were sent recently have been negative and the patient has had no blood in her diarrhea. Presumed cause is Augmentin, which has been stopped. The patient has continued to eat freely and is passing diarrhea despite her complaints of 10/10 severe abdominal pain. A CT scan of her abdomen was ordered, but she refused to take oral or IV contrast. The results of this CT scan are pending and will be followed up by the new medical team.
|
Has patient ever been prescribed toprol
|
{
"answer_end": [
727
],
"answer_start": [
702
],
"text": [
"Toprol 100 mg p.o. daily,"
]
}
|
RECORD #159637 was a 45-year-old male with multiple cardiac risk factors, including known CAD s/p MI (4/14 with PCI to LAD, complicated by instent thrombosis 1 week post-cath->successfully restented), HTN, dyslipidemia, obesity, and positive FHx who was admitted on 4/22/2003 with non-ischemic chest pain. He had an ETT-MIBI in 5/12 which showed large fixed defect in anterior, anteroseptal, anterolateral, inferior, LV apex with EF of 35%. On this occasion, he noted sudden onset of 8/10 chest pain while at rest at 6:30 pm on the evening of admission and was transported to Greena Hospital where his vitals were 98.2, 73, 92/62, 15. He was given IV TNG, heparin, MSO4, ASA with pain down to 4/10 and transferred to ITH. Ruling out ischemia by ensymes and ETT, the patient was discharged on 5/4/2003 with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Folic Acid 1 MG PO QD, Ativan (Lorazepam) 1 MG PO QHS, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain, Darvocet N 100 (Propoxyphene Nap./Acetaminophen) 1 TAB PO Q4H PRN Pain, Zocor (Simvastatin) 80 MG PO QHS, Norvasc (Amlodipine) 2.5 MG PO BID, Toprol XL (Metoprolol (Sust. Rel.)) 50 MG PO QD, Altace (Ramipril) 2.5 MG PO QD, Potassium Chloride IV (ref # 68076838) and Immed. Rel. PO (ref #) with Potentially Serious Interaction: Ramipril & Potassium Chloride, Clopidogrel 75 MG PO QD, Vioxx (Rofecoxib) 25 MG PO BID, Protonex (Pantoprazole) 40 MG PO QD, Diet: House/Low Chol/Low Sat. Fat, Activity: Resume Regular Exercise, Follow Up Appointments with Dr. Damon Krzeczkowski and Dr. Lon Willims, Allergy: Atarax (Hydroxyzine Hcl), Sulfa, Number of Doses Required (approximate): 3, and instructions to consider increasing CCB as patient seems to feel it helps his LH, dizziness and to adjust HTN meds as he was relatively hypotensive (SBP 90-110) in hospital (although asymptomatic) and outpatient cardiac rehabillitation.
|
Why was the patient on darvocet n 100 ( propoxyphene nap./acetaminophen )
|
{
"answer_end": [
1044
],
"answer_start": [
973
],
"text": [
"Darvocet N 100 (Propoxyphene Nap./Acetaminophen) 1 TAB PO Q4H PRN Pain,"
]
}
|
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week.
|
Was the patient ever given medication for pain
|
{
"answer_end": [
2766
],
"answer_start": [
2717
],
"text": [
"Tylenol 325 mg p.o. every four hours p.r.n. pain,"
]
}
|
This 66 year old African American woman presented with an acute stroke and was brought in by her daughter. She had a CTA done which showed questionable luminal narrowing of the distal left middle cerebral artery, and was given a 9 mg bolus dose of intravenous TPA over two minutes and 81 mg given over the following hour. Her past medical history includes diet controlled diabetes, obesity, hypertension, ulcerative colitis, a prior MI in 1988, and a possible old stroke. Her medications are aspirin 325 mg and Asacol, although she was unsure of the dose. Blood pressure was 138/76, heart rate was 80 and paced, and she had a right field compromise difficulty crossing the midline with a right upper motor neuron seventh weakness and decreased power on the right side of the face. After the TPA, her language returned completely to normal. Protocol for the stroke was followed, including blood pressure monitoring, nasal oxygen, and no antiplatelet therapy for 24 hours. Head of bed was raised to 30 degrees and a head CT was repeated the following morning. An echocardiogram showed normal ventricular size and systolic function, trace aortic insufficiency, trace mitral regurgitation, and persistent atrial flutter. She was coumadinized and discharged without rehabilitation on 0/21/99 on Coumadin with a plan for complete cardioversion within one month.
|
has there been a prior asacol
|
{
"answer_end": [
518
],
"answer_start": [
472
],
"text": [
"Her medications are aspirin 325 mg and Asacol,"
]
}
|
The 68-year-old female patient presented with lower extremity swelling and erythema at the lower pole of her sternal wound, and her past medical history includes hypertension, diabetes, hypothyroidism, hypercholesterolemia, COPD, GERD, depression, history of GI bleed on Coumadin therapy, and pulmonary hypertension. On admission, the patient was started on 1. Toprol 25 p.o. daily., 2. Valsartan 40 mg p.o. daily., 3. Aspirin 81 mg p.o. daily., 4. Plavix 75 mg p.o. daily., 6. Lasix 40 mg p.o. b.i.d., 7. Spironolactone 25 mg p.o. daily., 8. Simvastatin 20 mg p.o. daily., 9. Nortriptyline 50 mg p.o. daily., 10. Fluoxetine 20 mg p.o. daily., 11. Synthroid 88 mcg p.o. daily., and a Lasix drip and Diuril with antibiotics for coverage of possible lower extremity cellulitis. After transthoracic echocardiogram revealed an ejection fraction of 40% to 45% and a stable mitral valve, the patient was started on a Lasix drip and Diuril with improvement of symptoms, and the Pulmonary team was consulted and recommended regimen of Advair and steroid taper for her COPD, and she was empirically covered for pneumonia with levofloxacin and Flagyl and continued to diurese well on a Lasix drip. Her preadmission cardiac meds, as well as her Coumadin for atrial fibrillation, were restarted, and the patient required ongoing aggressive diuresis to eventually achieve a fluid balance of is negative 1 liter daily. Liver function tests, as well as amylase and lipase, were checked and noted to be normal, and the patient's nausea and vomiting resolved when her bowels began to move. The patient was discharged to home in good condition on hospital day #8 with medications including Enteric-coated aspirin 81 mg p.o. daily, Zetia 10 mg p.o. daily, Fluoxetine 20 mg p.o. daily, Advair Diskus one puff nebulized b.i.d., Lasix 60 mg p.o. b.i.d., NPH insulin 30 units subcutaneously q.p.m., NPH insulin 20 units subcutaneously q.a.m., Potassium slow release 30 mEq p.o. daily, Levofloxacin 500 mg p.o. q.24 h. x4 doses, Levothyroxine 88 mcg p.o. daily, Toprol-XL 100 mg p.o. daily, Nortriptyline 50 mg p.o. nightly, Prednisone taper 30 mg q.24 h. x3 doses, 20 mg q.24 h. x3 doses followed by a 10 mg q.24 h. x3 doses, then 5 mg q.24 h. x3 doses, Simvastatin 40 mg p.o. nightly, Diovan 20 mg p.o. daily, and Coumadin to be taken as directed to maintain INR 2 to 2.5 for atrial fibrillation, with followup appointments with her cardiologist, Dr. Schwarzkopf in one to two weeks with her cardiac surgeon, Dr. Carlough in four to six weeks, and VNA will monitor her vital signs, weight, and wounds, and the patient's INR and Coumadin dosing will be followed by S Community Hospital Anticoagulation Service at 300-135-5841.
|
What medications has the patient been prescribed for atrial fibrillation
|
{
"answer_end": [
1267
],
"answer_start": [
1188
],
"text": [
"Her preadmission cardiac meds, as well as her Coumadin for atrial fibrillation,"
]
}
|
Ms. Fought is a 50-year-old female with a history of bipolar disorder, schizophrenia, obstructive sleep apnea, hypertension, and diabetes who presented with right knee swelling, redness, and pain and was admitted to the Emergency Department. She was given therapeutic doses of heparin because of the concern of pain, as well as IV fluids, Oxycodone 5 mg to 10 mg p.o. q.4h. p.r.n. pain, Tylenol 650 mg p.o. q.4h. p.r.n. pain, Ibuprofen 600 mg q.6h. p.r.n. pain, Klonopin 1 mg p.o. at bedtime, Levofloxacin 500 mg p.o. daily for six days after the day of discharge, and NSAIDs, and was prescribed Lisinopril 10 mg daily, Lipitor 40 mg daily, Klonopin, MetroGel p.o. at bedtime, Lithium 900 mg at bedtime, Acebutolol 200 mg daily, and Risperdal 0.5 mg at bedtime, with no known drug allergies. She responded well to normal saline fluid boluses for a total of 3 liters over her hospital course, and was treated with Unasyn and vancomycin, and then switched to levofloxacin, with six more days after discharge from the hospital. Her bradycardia was resolved either over beta blockade or lithium toxicity, for which her beta-blocker was held and her lithium was also held, resulting in an improved heart rate in the 50s and 60s. Upon discharge, she was given instructions to draw blood for lithium level checks daily until it is below 0.5, at which time, she should be restarted on lithium 300 mg p.o. at bedtime, and to follow up with her primary care physician, Dr. Aurelio Gilberto Hencheck at Li County Hospital.
|
Was the patient ever given medication for pain.
|
{
"answer_end": [
425
],
"answer_start": [
387
],
"text": [
"Tylenol 650 mg p.o. q.4h. p.r.n. pain,"
]
}
|
This 64-year-old male with a history of coronary artery disease, CHF, EF of 15%, status post AVR, and NSTEMI initially presented to outside hospital with chief complaint of shortness of breath and was found to have a BNP of 747 as well as a troponin I of 0.43. He was diuresed, started on Carvedilol and improved, and placed on a heparin drip. His medications on admission included Aspirin 81, Lisinopril 20, Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d., Nystatin 500 b.i.d., Paxil 20 daily, Glipizide 10 daily, Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily, heparin drip and Spironolactone. During his hospital stay, he was continued on Aspirin, Plavix, beta-blocker and ACE inhibitor, which were titrated to effect, started on a statin and continued on Niaspan, and maintained on a nicotine patch. He was also prescribed Spironolactone 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, and Coumadin 5 mg p.o. at night. The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics, which were discontinued on admission and was encouraged to stop smoking. He had runs of ectopy and SVT, so was placed on a heparin drip. Left heart cath revealed wall defect consistent with a right coronary artery infarct and the patient was continued on Spironolactone. He was discharged in a stable condition on Aspirin 325 p.o. daily, Lisinopril 4 mg p.o. daily, Nicotine patch 14 mg per day topical, Spironolactone 25 mg p.o. daily, Paxil 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, Carvedilol 12.5 mg p.o. twice daily, Plavix 75 mg daily, Gemfibrozil 900 mg p.o. twice daily and Coumadin 5 mg p.o. at night, with instructions to follow up with PCP and Cardiology as well as EP, to check his daily weights and report any increases to his PCP, and to arrange to have his INR drawn on 6/21/06 and follow-up INRs to be drawn every seven days.
|
What medication did the patient take for right coronary artery infarct.
|
{
"answer_end": [
313
],
"answer_start": [
261
],
"text": [
"He was diuresed, started on Carvedilol and improved,"
]
}
|
Cristopher Ottilige is a 53 year old woman with a history of diabetes mellitus who presented with abdominal pain and fevers over two weeks duration. On admission, the patient was treated with Lasix 60 mg q day, Glyburide 5 mg q day, Labetalol 200 mg b.i.d., Flagyl 500 mg p.o. q 8 hours, Levofloxacin 500 mg p.o. q 24 hours, Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day. Physical examination revealed Cervical motion tenderness and Neurologic examination found the patient alert and oriented. Abdominal CT was notable for a 7 x 8 cm low density fluid collection in the region of the right adnexa and a 4 x 8 cm low density fluid collection in the left adnexa. The patient was initially managed on triple antibiotics, ampicillin, gentamicin, and Clindamycin for empiric antimicrobial coverage, with gentamicin eventually being switched to Levofloxacin. Neurologic symptoms of abdominal pain were initially managed with Demerol and Vistaril, and by discharge the patient was without pain and afebrile. The patient was discharged on b.i.d. Flagyl 500 mg p.o. q 8 hours, Levofloxacin 500 mg p.o. q 24 hours, Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day, with instructions to call the primary care physician for fevers greater than 100.5, chills, nausea, vomiting, and abdominal pain. The patient was referred to the gynecology oncology service for further follow up as an outpatient.
|
Why did the patient need clindamycin
|
{
"answer_end": [
807
],
"answer_start": [
744
],
"text": [
"gentamicin, and Clindamycin for empiric antimicrobial coverage,"
]
}
|
The patient is a 64 year-old gentleman with a history of chest discomfort, dyspnea on exertion and fatigue who was scheduled for a coronary artery bypass grafting. He had cardiac catheterization at Ryhoagberg Spisus Community Hospital on November, 1999 which demonstrated a 30% tapering lesion of the left main coronary artery, 70% proximal lesion of the left anterior descending coronary artery, 80% lesion distal to D1, 100% occlusion of his left circumflex and a 100% occlusion of his right coronary artery. On March, 1999, he underwent coronary artery bypass grafting times three with a left internal mammary artery to the left anterior coronary artery, saphenous vein graft to the aorta and a saphenous vein graft from the obtuse marginal to the aorta. His intraoperative course was uncomplicated and he was weaned to extubation and he was treated with stress steroids to prevent steroid withdrawal. He was taken back to the operating room for bleeding and was reintubated and was returned in good and stable condition to the intensive care unit on renal Dopamine. He was again extubated and was seen in consultation by the Gastrointestinal Service for a question of gastrointestinal bleed since there was a clot seen on the transesophageal echocardiogram probe at its withdrawal from his first surgery. The Gastrointestinal Service saw any evidence of any upper gastrointestinal bleed and he was maintained on H2 blockers. He was sent to the step down unit on routine postoperative day number two and his Captopril was increased for afterload reduction. He continued to improve and continued to have care for his respiratory situation with continued diuresis and nebulizer treatments and ambulation. He was discharged to the care of Dr. Lou Pineault at Potmend Rehabilitation Hospital, Moorlberl Street with medications including Prednisone 5 mg p.o. twice a day, Enteric coated aspirin 325 mg p.o. q. day, Zantac 150 mg p.o. twice a day, Niferex 150 mg p.o. twice a day, Atrovent nebulizer 0.5 mg four times a day, Timolol eye drops 0.5% one drop in both eyes twice a day, Atenolol 25 mg p.o. twice a day, Captopril 12.5 mg p.o. three times a day, Lasix 40 mg p.o. q. day, Potassium SR 20 mEq p.o. q. day, Simvastatin 40 mg p.o. q. day, and Ibuprofen 200-800 mg as needed for pain q.4-6h.
|
has the patient used steroids in the past
|
{
"answer_end": [
904
],
"answer_start": [
838
],
"text": [
"he was treated with stress steroids to prevent steroid withdrawal."
]
}
|
Ms. Lofstrom is a 57-year-old female with a past medical history of hypertension, diabetes mellitus, multinodular goiter, arthritis and questionable recurrent bouts of generalized weakness who was admitted for new onset of right sided weakness, right leg numbness and weakness, right arm clumsiness followed by dysarthria. Laboratory tests showed glucose of 353, sodium 138, potassium 4.9, chloride 98, CO2 28, BUN 33, creatinine 1.1, calcium 10.3, magnesium 2.0, troponin 0.09, white count 8.4, hematocrit 39.8, platelet count 367,000, PT 12.1, PTT 19.5, INR 1.0. An echocardiogram revealed evidence of concentric LVH with preserved systolic function, calculated ejection fraction of 55%, one plus tricuspid regurgitation and normal peak doppler flow velocity across the tricuspid valve. Carotid noninvasive studies showed no evidence of hemodynamically significant disease in either carotid artery. MRI showed a focal area of increased T2 signal in the posterior limb of the left internal capsule, close the genu and a similar smaller area of signal abnormality in the left globus pallidus adjacent to the left internal capsule abnormality. The patient had not taken her insulin for several days prior to admission, and was placed on her regular insulin schedule as well as a sliding scale with blood sugar between 150 and high 200s. Her medications included Hydrochlorothiazide 12.5 milligrams once a day, Norvasc 5 milligrams once a day, Taxol 28 milligrams once a day, Premarin 0.625 milligrams once a day, Trazodone, insulin 12 units of regular and 50 units of NPH in the morning and Ansaid 100 milligrams p.o. b.i.d. p.r.n. joint pain. She was also reportedly taking a baby aspirin 81 milligrams once a day, and was placed on subcu heparin and started on full dose aspirin 325 milligrams p.o. q.d. while her antihypertensives were held in order to maintain a systolic blood pressure between 140-160 with a diastolic blood pressure of 85-90. The patient was rehydrated with IV fluids, and close observation was paid to her electrolytes including her potassium. Rheumatology was consulted and recommended checking a urinalysis to check for red blood cells and casts, which showed no protein, no blood, 0-2 red blood cells, and no casts. He therefore suggested to continue aspirin, but in higher doses to alleviate her left shoulder pain. The patient's Norvasc continued to be held with excellent control of her blood pressure between systolic of 140-160, and should not be reinitiated until roughly ten days after her stroke. Social work was consulted due to a history of abuse by her husband, but no further abuse history was elicited since his death. The patient was considered stable and ready for discharge to a rehabilitation facility.
|
What was the indication for my patient's norvasc
|
{
"answer_end": [
2459
],
"answer_start": [
2343
],
"text": [
"The patient's Norvasc continued to be held with excellent control of her blood pressure between systolic of 140-160,"
]
}
|
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation.
|
What types of medications have been tried for a mrsa urinary tract infection. management
|
{
"answer_end": [
1166
],
"answer_start": [
1087
],
"text": [
"She completed a ten-day course of vancomycin for a MRSA urinary tract infection"
]
}
|
Mr. Kanaan is a 68-year-old gentleman with stage IV esophageal cancer who presented with progressive shortness of breath over the three days prior to admission and had a known ejection fraction of 20%. His medical regimen was maximized with an ACE inhibitor or statin and baby aspirin was started on him. He was admitted with diarrhea related to chemotherapy, pulmonary edema secondary to decompensated heart failure, and gout in his right great toe. He was diuresed with Lasix and torsemide in addition to his spironolactone dose with a goal of 1.5 liters a day and received Atrovent nebulizers to help with his shortness of breath, with the combination of dopamine, nesiritide, and Lasix drips being most effective. His medications included amiodarone, digoxin, colchicine, Atrovent, lisinopril, spironolactone, torsemide, Ativan, Zocor, and Prilosec, with instructions to follow up with his primary care doctor with DVT prophylaxis with Lovenox. He also received ferrous sulfate 325 mg daily, trazodone 50 mg at night, multivitamins one tablet daily, and simvastatin 80 mg at night. He was discharged home with oxygen to use overnight and when symptomatic.
|
has there been a prior simvastatin
|
{
"answer_end": [
1085
],
"answer_start": [
1058
],
"text": [
"simvastatin 80 mg at night."
]
}
|
The patient is a 75-year-old male with a history of coronary artery disease, status post five catheterization with a pacemaker in place, arthritis, gout, benign prostatic hypertrophy, hypertension, and myelodysplasia who presented with a history of lower gastrointestinal bleeds. He was transfused with four units of packed red blood cells and then transferred to the Siter Calvty Valley Hospital for further evaluation and treatment. On admission, his hematocrit was 32.9 and subsequent serial hematocrits over the following two days were stable. A right hemicolectomy was performed on hospital day number three to prevent further episodes and the procedure and recovery were unremarkable. He was started on sips on postoperative day number one and clear liquids on postoperative day number two. He was advanced to a regular house diet on postoperative day number four and was discharged to home with services on the day of discharge. The patient was seen by his cardiologist, Dr. Poette throughout his hospitalization and was noted to have a run of V-tach 10 beats, asymptomatic, no chest pain or discomfort, no shortness of breath. He was discharged on Allopurinol 300 mg p.o. q.d., atenolol 25 mg p.o. q.d., Colace 100 mg p.o. b.i.d. p.r.n. constipation, Percocet 1-2 tablets p.o. q.4h. p.r.n. pain, Zantac 150 mg p.o. b.i.d., and Flomax 0.8 mg p.o. q.d. He will follow up with Dr. Weigold, his hematologist, in 2-4 weeks and Dr. Condiff on 8/28/02.
|
What is the patient's current dose does the patient take of her atenolol
|
{
"answer_end": [
1258
],
"answer_start": [
1212
],
"text": [
"Colace 100 mg p.o. b.i.d. p.r.n. constipation,"
]
}
|
The patient was admitted on 5/5/2006 with a history of mechanical fall, with the attending physician being Dr. Clemente Armand Bolstad, with a full code status and disposition of Rehabilitation. Medications on Admission included Amiodarone 100 QD, Colace 100 bid, lasix 40mg QD, Glyburide 5mg bid, Plaquenil 200mg bid, Isordil 20mg tid, Lisinopril 20mg QD, Coumadin 5mg 3dys/week, 2.5mg 4dys/week, Norvasc 10mg QD, Neurontin 300mg TID, with APAP prn. An override was added on 10/2/06 by Gerad E. Dancy, PA for POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & WARFARIN with the reason for override being monitoring. The patient was rehydrated with IVF and PO's were encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable dose. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache. A CT pelvis showed a right adnexal cyst which will need further characterization by US and outpatient follow up. The patient has an extensive cardiac history and the fall is not likely related to a cardiac issue as it appears mechanical, with no syncope, chest pain, etc. She was diagnosed with an NSTEMI with a small TnI leak, likely demand related in the setting of hypovolemia and the fall. Enzymes trended down. She was dry on admission and rehydrated with IVF, PO's encouraged, and became euvolemic by 1/2. Her JVP was up to 12cm, although it was difficult to gauge her volume status due to TR. She had a prolonged QT on admission, on telemetry, of unclear etiology, possibly starvation. This was monitored on telemetry until ROMI and drugs that confound were avoided. The QTc resolved to low 500s and a DDD pacer was functioning with V-pacing at 60bpm. Additional medications included NATURAL TEARS (ARTIFICIAL TEARS) 2 DROP OU BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, PLAQUENIL SULFATE (HYDROXYCHLOROQUINE) 200 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP <110, MILK OF MAGNESIA (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO DAILY PRN Constipation, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM, NORVASC (AMLODIPINE) 10 MG PO DAILY HOLD IF: SBP <110, NEURONTIN (GABAPENTIN) 300 MG PO TID, NEXIUM (ESOMEPRAZOLE) 20 MG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, DULCOLAX RECTAL (BISACODYL RECTAL) 10 MG PR DAILY PRN Constipation, CLOTRIMAZOLE 1% TOPICAL TOPICAL TP BID, GLYBURIDE 5 MG PO BID, LASIX (FUROSEMIDE) 20 MG PO DAILY, and corrected pt restarted on lasix 20 qd on d/c. A PT consult was obtained 3/21 and to follow daily at rehab. Labs showed Na 146, CK 3320, CKMB 12.9, Trop 0.23--->0.10, AST 107, Cr 1.2-->1.6. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache, rehydrated with IVF, po's encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable
|
Why was milk of magnesia ( magnesium hydroxide ) originally prescribed
|
{
"answer_end": [
2186
],
"answer_start": [
2106
],
"text": [
"MILK OF MAGNESIA (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO DAILY PRN Constipation,"
]
}
|
RECORD #159637 was a 45-year-old male with multiple cardiac risk factors, including known CAD s/p MI (4/14 with PCI to LAD, complicated by instent thrombosis 1 week post-cath->successfully restented), HTN, dyslipidemia, obesity, and positive FHx who was admitted on 4/22/2003 with non-ischemic chest pain. He had an ETT-MIBI in 5/12 which showed large fixed defect in anterior, anteroseptal, anterolateral, inferior, LV apex with EF of 35%. On this occasion, he noted sudden onset of 8/10 chest pain while at rest at 6:30 pm on the evening of admission and was transported to Greena Hospital where his vitals were 98.2, 73, 92/62, 15. He was given IV TNG, heparin, MSO4, ASA with pain down to 4/10 and transferred to ITH. Ruling out ischemia by ensymes and ETT, the patient was discharged on 5/4/2003 with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Folic Acid 1 MG PO QD, Ativan (Lorazepam) 1 MG PO QHS, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain, Darvocet N 100 (Propoxyphene Nap./Acetaminophen) 1 TAB PO Q4H PRN Pain, Zocor (Simvastatin) 80 MG PO QHS, Norvasc (Amlodipine) 2.5 MG PO BID, Toprol XL (Metoprolol (Sust. Rel.)) 50 MG PO QD, Altace (Ramipril) 2.5 MG PO QD, Potassium Chloride IV (ref # 68076838) and Immed. Rel. PO (ref #) with Potentially Serious Interaction: Ramipril & Potassium Chloride, Clopidogrel 75 MG PO QD, Vioxx (Rofecoxib) 25 MG PO BID, Protonex (Pantoprazole) 40 MG PO QD, Diet: House/Low Chol/Low Sat. Fat, Activity: Resume Regular Exercise, Follow Up Appointments with Dr. Damon Krzeczkowski and Dr. Lon Willims, Allergy: Atarax (Hydroxyzine Hcl), Sulfa, Number of Doses Required (approximate): 3, and instructions to consider increasing CCB as patient seems to feel it helps his LH, dizziness and to adjust HTN meds as he was relatively hypotensive (SBP 90-110) in hospital (although asymptomatic) and outpatient cardiac rehabillitation.
|
What is the current dose of the patient's folic acid
|
{
"answer_end": [
876
],
"answer_start": [
854
],
"text": [
"Folic Acid 1 MG PO QD,"
]
}
|
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 there been a prior novolog
|
{
"answer_end": [
2581
],
"answer_start": [
2554
],
"text": [
"his home regimen of Novolog"
]
}
|
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.
|
What is the patient's current dose does the patient take of her cardizem cd
|
{
"answer_end": [
962
],
"answer_start": [
899
],
"text": [
"Azmacort 4 puffs inhaler b.i.d., Cardizem CD 300 mg p.o. q.day,"
]
}
|
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.
|
Was the patient ever prescribed miconazole nitrate
|
{
"answer_end": [
1323
],
"answer_start": [
1260
],
"text": [
"SERIOUS INTERACTION: MICONAZOLE NITRATE & ATORVASTATIN CALCIUM,"
]
}
|
A 43-year-old morbidly obese female with a history of obstructive sleep apnea (OSA) presented with fatigue, shortness of breath, orthopnea, cough, and lower extremity edema (LEE), thought to be congestive heart failure (CHF). The patient was admitted on 6/19/2000 and was prescribed a diet of House/Low chol/low sat. fat, and was given instructions to follow up with Dr. Schak one week, Dr. Hartis next week, and Dr. Chionchio nest available. She had definite iron deficiency anemia (IDA) and was treated with iron intravenously. A gyn appointment was recommended with Flagyl for bacterial vaginosis (BV). The patient was treated with TYLENOL (ACETAMINOPHEN) 650-1,000 MG PO Q4-6H PRN headache, TYLENOL LIQUID (ACETAMINOPHEN ELIXER) 650-1,300 MG PO Q4-6H PRN headache, TYLENOL #3 (ACETAMINOPHEN W/CODEINE 30MG) 1-2 TAB PO Q4H PRN pain with instructions to not exceed a max dose of tylenol of 4gram/day, LAC-HYDRIN 12% (AMMONIUM LACTATE 12%) TOPICAL TP BID with instructions to lower extremities, CEPACOL 1 LOZENGE PO Q4H PRN sore throat, FLAGYL (METRONIDAZOLE) 500 MG PO BID X 5 Days with instructions to take with food, METAMUCIL SUGAR FREE (PSYLLIUM (METAMUCIL) SUGAR FREE) 1 PACKET PO QD PRN CONSTIPATION, DICLOXACILLIN 500 MG PO QID X 12 Days with instructions to give on an empty stomach and LISINOPRIL 20 MG PO QD. The patient was also instructed to inhale steroids or claritin, and was consented for iv treatment, with a tolerance for iron iv, and was prescribed Flagyl for BV. The patient was also given a flu shot and pneumovax. The patient has allergies to Aspirin, Iron (ferrous sulfate), and Nsaid's. The patient was not compliant with CPAP at night due to feeling of suffocating and was also refusing inpatient rehabilitation despite assistance from social work and care coordinators with home and bills issues. An EKG with possible lateral strain was also done. The patient was refusing BP medication because she claimed she did not have high BP, and was treated with Dicloxacillin for cellulitis. She was recommended to follow-up with Dr. Fridal and Dr. Trezza in one week and to see Dr. Knipple at the next available appointment. She was also to get a VNA for every other day to do a respiratory evaluation and assistance with medical care, as well as physical therapy/occupational therapy twice weekly. The patient was to use CPAP at 18-19 cm H2O for 8 hours a night with oxygen at 4-5L and with ambulation, and to do sitz baths to vagina twice a day. She was instructed to call her doctor if she was short of breath, had chest pain, nausea/vomiting, worsening leg pain, headaches, or other worrisome symptoms. She was discharged on 9/10/2000 with a code status of Full code and disposition of Home w/ services in a stable condition.
|
When the the patient last receive flagyl ( metronidazole )
|
{
"answer_end": [
1083
],
"answer_start": [
1038
],
"text": [
"FLAGYL (METRONIDAZOLE) 500 MG PO BID X 5 Days"
]
}
|
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.
|
Has the patient ever tried multivitamins
|
{
"answer_end": [
666
],
"answer_start": [
647
],
"text": [
"cough medicine PRN."
]
}
|
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
|
Is there history of use of lopressor
|
{
"answer_end": [
1861
],
"answer_start": [
1785
],
"text": [
"The patient was given Lopressor 100 mg b.i.d. to control the blood pressure,"
]
}
|
Ms. Christin is an 80-year-old female who presented to an outside hospital with chest pain and shortness of breath. She took one sublingual Nitroglycerin without relief, followed by two more without relief and was then treated with intravenous Lasix, morphine, and Nitroglycerin which resulted in resolution of her pain. Her medical history includes hypertension, hypercholesterolemia, angina, Paget's disease, anemia, and osteoarthritis. An EKG at the hospital showed anterolateral ST depression and her enzymes were negative, ruling out myocardial infarction. Her cardiac symptomatology began in the fall of 1999 and evaluation showed high cholesterol with an LDL 141, EKG with LVH and nonspecific T wave flattening, and a Thallium stress test that was stopped secondary to shortness of breath. Upon admission to Ster Hospital for evaluation of her angina, her laboratory values were consistent with a myocardial infarction and her peak CK was 459 with an MB of 28.7. Her discharge medications include Aspirin 81 mg daily, iron 300 mg three times a day, Hydrochlorothiazide 25 mg daily, Lisinopril 5 mg daily, multivitamin one daily, Relafen 500 mg orally a day, Imdur 60 mg orally a day, Plavix 75 mg daily for 29 days, Lipitor 40 mg daily, Atenolol 25 mg orally a day, and magnesium oxide 420 mg daily. Follow-up with Dr. Porter Luckenbaugh in SH Cardiovascular Group on January at 1:00 p.m. and with Dr. Sammy Kleindienst in the Greenetons Opi Hospital Hematology Clinic.
|
What is has been given for treatment of her her pain
|
{
"answer_end": [
260
],
"answer_start": [
210
],
"text": [
"was then treated with intravenous Lasix, morphine,"
]
}
|
Patient Mariano Librizzi was admitted on 4/21/2005 with a viral infection and severe pulmonary hypertension, and discharged on 9/22/2005 to go home. The discharge medications included ECASA (Aspirin Enteric Coated) 81 MG PO QD, with a potentially serious interaction with Warfarin & Aspirin, COLACE (Docusate Sodium) 100 MG PO BID, LASIX (Furosemide) 160 MG PO BID, GLIPIZIDE 10 MG PO BID, OCEAN SPRAY (Sodium Chloride 0.65%) 2 SPRAY NA QID, COUMADIN (Warfarin Sodium) 5 MG PO QPM, JERICH, JOSPEH, M.D. on order for ECASA PO (ref #91585860), ZOLOFT (Sertraline) 150 MG PO QD, AMBIEN (Zolpidem Tartrate) 10 MG PO QHS, KCL SLOW RELEASE 20 MEQ PO BID, ATROVENT NASAL 0.06% (Ipratropium Nasal 0.06%) 2 SPRAY NA TID, NEXIUM (Esomeprazole) 20 MG PO QD, TRACLEER (Bosentan) 125 MG PO BID, VENTAVIS 1 neb NEB Q3H Instructions: during wake hours, ALBUTEROL INHALER 2 PUFF INH Q4H PRN Shortness of Breath, Wheezing, home O2 (8L NC). The patient was also prescribed K-Dur 20 BID, Nexium 20, Lasix 160 BID, Tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft 100, MVI, Oceanspray 2 Spray NA QID, Ambien 10 QHS, Ventavis nebs Q3H, Albuterol Inhaler 2 puff INH Q4H, KCl Slow Release 20 MEQ PO BID, Colace 100 MG PO BID, Atrovent Nasal 0.06%. The diet was House/Low chol/low sat. fat and 4 gram Sodium and they were advised to do walking as tolerated, with serial enzymes/EKG to be continued and Lasix, KCl, ASA 81 also advised. The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien, and to avoid high Vitamin-K containing foods and to give on an empty stomach (give 1hr before or 2hr after food). The patient was followed by the AH service with ACEi, cephalopsporins, GERD nexium prophylaxis and Coumadin for pulmonary microclots on Bx in tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft. The discharge condition was satisfactory.
|
Has the patient ever been on ambien.
|
{
"answer_end": [
1546
],
"answer_start": [
1431
],
"text": [
"The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien,"
]
}
|
This is a 66-year-old man with diabetes, hypertension, obesity and non-Hodgkin's lymphoma of the right hip on chemotherapy (R-CHOP) which began on 4/10/06 and will continue for 18 weeks, reporting no complications from ischemic chemotherapy. The patient presented to the emergency room with syncope and was hypotensive on arrival, receiving IV normal saline as volume resuscitation. The second set of cardiac enzymes was positive with a troponin of 2, and an echocardiogram the morning following admission showed a dilated right ventricle consistent with right ventricular strain. A PE protocol CT scan showed a large saddle embolus, and the patient was treated initially with IV heparin, transitioned to Coumadin and then the decision was made to try Lovenox therapy for long-term anticoagulation. Cardiac enzymes normalized and repeat echocardiogram showed mild improvement in right heart function. On admission, the patient's medications were Atenolol 50 daily, lisinopril 5 daily, Protonix 40 daily, metformin 1500 daily, Lantus 60 daily, Humalog 20 before meals, Byetta 5 mcg twice daily, levothyroxine (dose unknown), OxyContin 40 every eight hours, Percocet two tabs every 3 hours as needed for pain and gabapentin (dose unknown).
|
What was the dosage prescribed of percocet
|
{
"answer_end": [
1237
],
"answer_start": [
1124
],
"text": [
"OxyContin 40 every eight hours, Percocet two tabs every 3 hours as needed for pain and gabapentin (dose unknown)."
]
}
|
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty.
|
has there been a prior nitroglycerin
|
{
"answer_end": [
457
],
"answer_start": [
383
],
"text": [
"She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine,"
]
}
|
Patient DOUGLASS W. DILEO was admitted to CAR with unstable angina and discharged on 11/23/04 with a code status of full code and disposition of home w/ services. The patient has a possible allergy to NSAIDs with reaction unknown and a probable allergy to SIMVASTATIN, NSAIDs, SHELLFISH, and Codeine. The patient was given atropine and Fem stop placed over cath due to femoral hematoma. CT ruled out retroperitoneal bleed and her HCT dropped from 32 to 26, and she was transfused 2 U PRBC. The anti-ischemic regimen at discharge included ENTERIC COATED ASA (ASPIRIN ENTERIC COATED) PO 325 MG QD (ref #57541802), INSULIN NPH HUMAN 36 UNITS QAM; 40 UNITS QPM SC, NEURONTIN (GABAPENTIN) 600 MG PO BID, PLAVIX (CLOPIDOGREL) 75 MG PO QD, ZETIA (EZETIMIBE) 10 MG PO QD, LISINOPRIL 40 MG PO QD, HYDROCHLOROTHIAZIDE 25 MG PO QD, PREVACID (LANSOPRAZOLE) 30 MG PO QD, GLUCOPHAGE (METFORMIN) 1,000 MG PO BID, and ATENOLOL 25 MG PO QD, with no statin due to muscle pain history. The patient was instructed to take 1/2 their regular home dose of Atenolol until they see their cardiologist/PCP, and to follow a diet of house/low chol/low sat. fat and house/ADA 2100 cals/dy. Patient was to follow up with Dr. Brechbiel in 2 weeks and Dr. Damms for right leg ultrasound in 2-4 weeks. The patient also had a below-the knee right tibial vein DVT, was not anticoagulated for this below-the knee clot because of low risk of embolization and her recent HCT drop/hematoma. The patient was also given IBUPROFEN 600-800 MG PO Q6H PRN Pain for left knee pain after a fall one week prior. The patient was instructed to continue home diabetic regimen and followup with PCP/cardiology and schedule a repeat right leg ultrasound test (“LENI”) to follow the small blood clot in her leg in the future.
|
What is the dosage of lisinopril
|
{
"answer_end": [
787
],
"answer_start": [
764
],
"text": [
"LISINOPRIL 40 MG PO QD,"
]
}
|
This 64-year-old male with a history of coronary artery disease, CHF, EF of 15%, status post AVR, and NSTEMI initially presented to outside hospital with chief complaint of shortness of breath and was found to have a BNP of 747 as well as a troponin I of 0.43. He was diuresed, started on Carvedilol and improved, and placed on a heparin drip. His medications on admission included Aspirin 81, Lisinopril 20, Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d., Nystatin 500 b.i.d., Paxil 20 daily, Glipizide 10 daily, Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily, heparin drip and Spironolactone. During his hospital stay, he was continued on Aspirin, Plavix, beta-blocker and ACE inhibitor, which were titrated to effect, started on a statin and continued on Niaspan, and maintained on a nicotine patch. He was also prescribed Spironolactone 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, and Coumadin 5 mg p.o. at night. The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics, which were discontinued on admission and was encouraged to stop smoking. He had runs of ectopy and SVT, so was placed on a heparin drip. Left heart cath revealed wall defect consistent with a right coronary artery infarct and the patient was continued on Spironolactone. He was discharged in a stable condition on Aspirin 325 p.o. daily, Lisinopril 4 mg p.o. daily, Nicotine patch 14 mg per day topical, Spironolactone 25 mg p.o. daily, Paxil 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, Carvedilol 12.5 mg p.o. twice daily, Plavix 75 mg daily, Gemfibrozil 900 mg p.o. twice daily and Coumadin 5 mg p.o. at night, with instructions to follow up with PCP and Cardiology as well as EP, to check his daily weights and report any increases to his PCP, and to arrange to have his INR drawn on 6/21/06 and follow-up INRs to be drawn every seven days.
|
Has the patient had multiple plavix prescriptions
|
{
"answer_end": [
476
],
"answer_start": [
409
],
"text": [
"Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d.,"
]
}
|
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06.
|
has there been a prior cardiac medications
|
{
"answer_end": [
770
],
"answer_start": [
719
],
"text": [
"were continued due to the patient's cardiac stents."
]
}
|
Mr. Sherburn is a 58 yo man with a history of Hodgkins lymphoma who underwent radiation therapy, hypertension, and non-Q wave MI and was admitted to LMC for cardiac catheterization and observation s/p cath. During the procedure, a chronic total occlusion of the proximal L.circumflex artery with collaterals to distal vessels was observed, as well as an RCA ostial discrete 45% lesion. Mr. Muthart tolerated the procedure well without adverse event or complication at the groin site, remaining afebrile, with stable electrolytes, hematocrit and WBC. EKG was without evidence of acute ischemia and cardiac enzymes remained flat, with his SBP running in the 90's to low 100's and his Lisinopril was decreased as a result. Imdur was also added to his cardiac regimen. The discharge medications were ALBUTEROL INHALER 2 PUFF INH QID PRN SOB, ECASA ( ASPIRIN ENTERIC COATED ) 325 MG PO QD, ATENOLOL 50 MG PO QD Food/Drug Interaction Instruction, LISINOPRIL 5 MG PO QD, NITROGLYCERIN 1/150 ( 0.4 MG ) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], TERBUTALINE ( TERBUTALINE SULFATE ) 5 MG PO QID, AZMACORT ( TRIAMCINOLONE ACETONIDE ) 2 PUFF INH QID, KEFLEX ( CEPHALEXIN ) 500 MG PO QID, and IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 30 MG PO QD Food/Drug Interaction Instruction. Mr. Sherburn was discharged to home with a code status of full code and a diet of House / Low chol/low sat. fat, and was instructed to return to work after an appointment with a local physician. Follow up appointments with Dr. Ned Wendt (Cardiology 3/30/01), and Dr. Elias Forgey (SMH) were scheduled, and allergies to shellfish and morphine were reported.
|
Has this patient ever tried azmacort ( triamcinolone acetonide )
|
{
"answer_end": [
1152
],
"answer_start": [
1100
],
"text": [
"AZMACORT ( TRIAMCINOLONE ACETONIDE ) 2 PUFF INH QID,"
]
}
|
Patient Mariano Librizzi was admitted on 4/21/2005 with a viral infection and severe pulmonary hypertension, and discharged on 9/22/2005 to go home. The discharge medications included ECASA (Aspirin Enteric Coated) 81 MG PO QD, with a potentially serious interaction with Warfarin & Aspirin, COLACE (Docusate Sodium) 100 MG PO BID, LASIX (Furosemide) 160 MG PO BID, GLIPIZIDE 10 MG PO BID, OCEAN SPRAY (Sodium Chloride 0.65%) 2 SPRAY NA QID, COUMADIN (Warfarin Sodium) 5 MG PO QPM, JERICH, JOSPEH, M.D. on order for ECASA PO (ref #91585860), ZOLOFT (Sertraline) 150 MG PO QD, AMBIEN (Zolpidem Tartrate) 10 MG PO QHS, KCL SLOW RELEASE 20 MEQ PO BID, ATROVENT NASAL 0.06% (Ipratropium Nasal 0.06%) 2 SPRAY NA TID, NEXIUM (Esomeprazole) 20 MG PO QD, TRACLEER (Bosentan) 125 MG PO BID, VENTAVIS 1 neb NEB Q3H Instructions: during wake hours, ALBUTEROL INHALER 2 PUFF INH Q4H PRN Shortness of Breath, Wheezing, home O2 (8L NC). The patient was also prescribed K-Dur 20 BID, Nexium 20, Lasix 160 BID, Tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft 100, MVI, Oceanspray 2 Spray NA QID, Ambien 10 QHS, Ventavis nebs Q3H, Albuterol Inhaler 2 puff INH Q4H, KCl Slow Release 20 MEQ PO BID, Colace 100 MG PO BID, Atrovent Nasal 0.06%. The diet was House/Low chol/low sat. fat and 4 gram Sodium and they were advised to do walking as tolerated, with serial enzymes/EKG to be continued and Lasix, KCl, ASA 81 also advised. The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien, and to avoid high Vitamin-K containing foods and to give on an empty stomach (give 1hr before or 2hr after food). The patient was followed by the AH service with ACEi, cephalopsporins, GERD nexium prophylaxis and Coumadin for pulmonary microclots on Bx in tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft. The discharge condition was satisfactory.
|
Has the patient ever been on ventavis
|
{
"answer_end": [
837
],
"answer_start": [
782
],
"text": [
"VENTAVIS 1 neb NEB Q3H Instructions: during wake hours,"
]
}
|
Ms. Dube is a 58-year-old female with non-insulin dependent diabetes mellitus, hyperlipidemia, hypertension, and a history of a left circumflex coronary artery stent placed three months prior to admission. She presented to the emergency room with left jaw pain, which was relieved with three sublingual nitroglycerin and later with Percocet to which she got some relief. She was started on Lovenox 1 mg per kg subcutaneously b.i.d., beta-blocker, Zocor and ACE inhibitor, t.i.d., glucophage 500 mg b.i.d., Celexa 40 mg p.o. q.d., Zestril 2.5 mg q.d., atenolol 25 mg p.o. q.d., Lipitor 20 mg p.o. q.h.s., Plavix. The patient's Lovenox was reversed with protamine and her hematoma continued to expand overnight, so she received one unit of fresh frozen plasma as well as a third unit of packed red blood cells, resulting in a total of five units of packed red blood cells due to blood loss secondary to her anticoagulation with Lovenox, Plavix, aspirin and a possible STONDE MEDICAL CENTER trial drug. Her headache was treated with Tylenol to which it did not respond and her discharge medications included aspirin 81 mg p.o. q day, Klonopin 0.5 mg p.o. q.h.s., and her home medications of Zocor, Lopressor, captopril, Celexa, Klonopin. Vascular surgery was consulted due to concern for developing compartment syndrome and she was restarted on aspirin. Her head CT was negative for bleeding and she was discharged home on March, 2003 with instructions to follow up with her primary care physician.
|
Has this patient ever been treated with celexa
|
{
"answer_end": [
529
],
"answer_start": [
480
],
"text": [
"glucophage 500 mg b.i.d., Celexa 40 mg p.o. q.d.,"
]
}
|
This 57-year-old female with a distant history of ovarian cancer, rheumatoid arthritis with systemic lupus erythematosus features, and history of TTP, status post splenectomy, was admitted with fever, shortness of breath, and pleuritic chest pain. She was initially given cefuroxime and levofloxacin in the emergency department for a presumed community acquired pneumonia, as well as Lasix. Her medications included diltiazem 240 mg a day, lisinopril 40 mg a day, Naprosyn 500 mg b.i.d., NPH insulin 24 units subcutaneously q.a.m., Entex-LA, and Cardizem-CD 240 mg p.o. q.d. She underwent thoracentesis and multiple bilateral therapeutic pleuracentesis, and was diuresed aggressively with Lasix, with her oxygen requirement being down from initially 5 to 6 liters per nasal cannula prior to discharge. A continuous Doppler wave form was found and she underwent abdominal CT scan, which did not show any evidence of venous or lymphatic obstruction. Initially, she was started on cefuroxime and azithromycin by the General Medicine team, and her Legionella urine antigen became positive and levofloxacin was added given recommendations from the Infectious Disease Service. She was off of O2 except that she had desaturations to 86% with ambulation, therefore, she was discharged home with p.r.n. oxygen, on Lasix 80 mg b.i.d., insulin sliding scale, lisinopril 40 mg a day, and Cardizem-CD 240 mg p.o. q.d. and levofloxacin 500 mg times 14 days. An elevated platelet count up to 800 and an elevated CA-125 level was discussed with her GYN oncologist, and she was to follow-up with her doctor in one week.
|
Previous lisinopril
|
{
"answer_end": [
463
],
"answer_start": [
440
],
"text": [
"lisinopril 40 mg a day,"
]
}
|
The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg
|
Is there a mention of of lisinopril usage/prescription in the record
|
{
"answer_end": [
1412
],
"answer_start": [
1331
],
"text": [
"prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 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.
|
What medications has the patient been prescribed for hypertensive
|
{
"answer_end": [
1259
],
"answer_start": [
1176
],
"text": [
"was treated with Hydralazine initially and transitioned to his p.o. home medicines,"
]
}
|
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty.
|
Has the patient ever tried neurontin
|
{
"answer_end": [
2211
],
"answer_start": [
2130
],
"text": [
"were discontinued and she was placed on Neurontin for likely diabetic neuropathy."
]
}
|
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.
|
Is the patient currently or have they ever taken torsemide
|
{
"answer_end": [
578
],
"answer_start": [
505
],
"text": [
"oral torsemide, and heparin while starting anticoagulation with Coumadin."
]
}
|
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 a patient had regular insulin
|
{
"answer_end": [
1016
],
"answer_start": [
976
],
"text": [
"placed on Regular Insulin sliding scale."
]
}
|
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.
|
insulin 70/30
|
{
"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 58-year-old female with chronic renal insufficiency, diabetes mellitus, hypertension, and anemia who presented with two weeks of diffuse abdominal pain that acutely worsened one day prior to admission with associated nausea, nonbloody emesis, and chills. She was initially given a seven-day course of ciprofloxacin and oxycodone for pain, but stopped taking them after developing constipation. She currently presents with complaints of diarrhea and was given ampicillin 2 g IV, gentamicin 80 mg IV, Flagyl 500 mg IV and 8 units of insulin. She was put on levofloxacin, vancomycin, and Flagyl as her left foot had been encasted with evidence of underlying infection, and her blood cultures grew MRSA, which is presumed to need eight weeks of vancomycin. She was put on erythromycin with a change to Reglan on 8/6/06 per renal or liver disease and kept on Compazine for nausea. Later, it was determined that the patient was iron deficient and she was put on iron supplementation and darbepoetin initially and changed to erythropoietin later during dialysis. She was maintained on aspirin, a statin, and calcium channel blocker, and started on prophylactic beta-blocker during her hospital course. Her insulin regimen was titrated to good glycemic response, and she was kept on heparin and Nexium. Other medications included Tylenol 650 mg p.o. q.4. p.r.n. headache, Colace 100 mg p.o. b.i.d., Dilaudid 0.4-0.8 mg p.o. q.4. p.r.n. pain, Insulin NPH human 20 units subq b.i.d., Lopressor 50 mg p.o. q.i.d., Senna tablets two tabs p.o. b.i.d., Norvasc 10 mg p.o. daily, Nephrocaps one tab p.o. daily, Insulin Aspart sliding scale subq a.c., Lipitor 80 mg p.o. daily, Protonix 40 mg p.o. daily, Vancomycin 1 g IV three times a week, Reglan 5 mg p.o. q.a.c., Reglan 5 mg p.o. q.h.s., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Ergocalciferol 50,000 units p.o. q. week for six weeks, Aspirin 81 mg p.o. daily, Heparin 5000 units subq t.i.d., and Lactulose 30 mL p.o. q.i.d. p.r.n. constipation.
|
Has the patient had multiple statin prescriptions
|
{
"answer_end": [
1211
],
"answer_start": [
1106
],
"text": [
"statin, and calcium channel blocker, and started on prophylactic beta-blocker during her hospital course."
]
}
|
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 a patient had ecasa ( aspirin enteric coated )
|
{
"answer_end": [
212
],
"answer_start": [
168
],
"text": [
"ECASA (Aspirin Enteric Coated) 325 MG PO QD,"
]
}
|
This is a 66-year-old man with spinal sarcoidosis and secondary paraplegia who presented with altered mental status, hypoxemic respiratory failure, and hypotension. He became hypotensive with intubation despite using etomidate with Levophed, and was started on vancomycin, gentamicin, Flagyl, and stress dose steroids with 1 liter of IV fluid. His urine was found to have Proteus, resistant to Macrobid, and Klebsiella, resistant to ampicillin, so he was started on Levophed with a systolic blood pressure in the 130's on 7 to 10 of Levophed and Levofloxacin was continued at 500 mg per day for a total 10-day course on in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, to end on 10/16/2006 for a total course of 10 days. Urology replaced the suprapubic catheter and he was started on maintenance IV fluids until cleared to eat by Speech and Swallow. His home medications included Regular Insulin sliding scale a.c. and at bedtime, NPH 54 units in the morning and 68 units in the night, baclofen 10 mg t.i.d., amitriptyline 25 mg at bedtime, oxybutynin 5 mg t.i.d., gabapentin 300 mg t.i.d., iron sulfate 325 mg t.i.d., vitamin C 500 mg daily, magnesium 420 mg t.i.d., Coumadin 5 mg daily, ranitidine 150 mg b.i.d., and calcium 950 mg daily. He was given a head CT without contrast and a chest x-ray that showed no obvious infiltrate. His INR was found to be elevated and he had a suprapubic catheter obstruction with bilateral hydronephrosis and distended bladder. He was given Nexium and Coumadin for prophylaxis and was started on a low dose of captopril on 8/14/2006 for diabetes, and was started on 12.5 mg b.i.d. metoprolol on 0/14/2006 with good results. He was given NPH 20 b.i.d. through his hospitalization and Regular Insulin sliding scale. His creatinine came down to 1.2 and he was given the new beta-blocker and the ACE inhibitor as well as baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate 325 mg p.o. t.i.d., gabapentin 300 mg p.o. t.i.d., NPH human insulin 54 units in the morning, 68 units in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, magnesium oxide 420 mg p.o. t.i.d., metoprolol 12.5 mg p.o. b.i.d., oxybutynin 5 mg p.o. t.i.d., Panafil ointment t.i.d., and ranitidine 500 mg p.o. b.i.d. He was admitted with severe sepsis due to UTI, suprapubic catheter/ostomy for 12 years, diabetes type II, right DVT, on Coumadin, status post chronic UTI, and CPAP at night for pneumonia with ceftazidime, levofloxacin, and vancomycin. His sugars were controlled with no complications and was able to maintain blood pressures in the 130's. His creatinine was initially 2.7, and after receiving IV fluids, it came down to 1.2. He likely had acute renal failure secondary to postrenal obstructive etiology. His INR was found to be therapeutic and he had half of his home Coumadin dose while he was on levofloxacin, so he was given half of dose and his INRs came down to a nadir of 1.7. At discharge, his hematocrit was 27.2, down from 29, which was closed to his baseline of 34, and his INR was 2.1. He was placed on maintenance IV fluids until cleared to eat by Speech and Swallow, and was given amitriptyline 25 mg p.o. at bedtime, vitamin C 500 mg p.o. daily, baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate
|
beta-blocker
|
{
"answer_end": [
1911
],
"answer_start": [
1817
],
"text": [
"he was given the new beta-blocker and the ACE inhibitor as well as baclofen 10 mg p.o. t.i.d.,"
]
}
|
This is a 65-year-old female with a history of coronary artery disease, hypertension, diabetes, IPF diagnosed in 1986, osteoarthritis, and obesity who presented with five days of chest pain/SOB. She was initially put on aspirin, Lopressor 37.5 t.i.d., heparin, oxygen and hooked up to a cardiac monitor and EKG q.d. and was ruled out for unstable angina. Cardiac catheterization revealed LAD ostial 90%, proximal 80%, diag ostial 90%, left circ 90%, 80% lesions, marginal 1, TUB 90%, RCA 50%. The patient underwent PTCA and stent x 2 with good results and remained chest pain free. On admission she was on medications Captopril 50 mg b.i.d., Lasix 40 mg q.d., Lopid 600 mg b.i.d., Axid 150 mg b.i.d., and insulin 70/30 90 q. a.m. and 40 q. p.m. The patient was hypokalemic on 10/23 with a curious whitening on EKG and peak T waves and was treated with insulin, calcium, and Kayexalate x 3. She had a history of colonic polyps but tolerated the aspirin and was put on Nexium prophylaxis. She was then treated with prednisone overnight for IV contrast dye allergy and treated with digoxin and prednisone. The patient was treated with levofloxacin 500 mg q.d. for fourteen days and discharged on medications ASA 325 mg p.o.q.d., atenolol 75 mg p.o. b.i.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. b.i.d., nitroglycerin 1/150 one tab q. 5 minutes x 3 p.r.n. chest pain, Zocor 10 mg p.o. q.h.s., Norvasc 5 mg p.o.q.d., xalatan one drop OU q.h.s., Alphagan one drop OU b.i.d., levofloxacin 500 mg p.o.q.d., clopidogrel 75 mg p.o.q.d., insulin 70/30 90 units q.a.m., 40 units q.p.m. subcu, and Axid 150 mg p.o. b.i.d.
|
Has this patient ever been prescribed digoxin
|
{
"answer_end": [
1102
],
"answer_start": [
1066
],
"text": [
"treated with digoxin and prednisone."
]
}
|
Jonas G Fosselman was admitted from office on 4/1/01 for infected L THR. Aspiration demonstrated purulent material, and he was started on Ceftriaxone per ID consult recs. with MIC to both PCN and Ceftriaxone pending. MRI of pelvis completed 10/10/01 as pre-op eval. TU Cardiology was consulted for pre-op clearance given extensive H/O cardiomyopathy and unstentable CAD per last cardiac cath 8/7. On further d/w PT, he was adament about being allowed to be D/C home on Abx for August holiday. Given that his clinical picture was much improved on antibiotics, both Dr Salkeld and ID MD agreed to this on provision that he return immediately for any evidence of progressing infection. His R hip pain and exam were much improved by time of discharge. Will plan for IV lon line to be placed prior to D/C for home dosing of QD Ceftriaxone. ID to be re-consulted on admission post-op 10/5 for re-eval of abx choice. By that time it is presumed that the MIC for PCN/CTX will be available for ascertation of proper long-term Abx care. Discharge medications included TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN headache, VENTOLIN (ALBUTEROL INHALER) 1-2 PUFF INH QID PRN sob/wheeze, ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, ATENOLOL 25 MG PO QD Food/Drug Interaction Instruction Take consistently with meals or on empty stomach., CEFTRIAXONE 2,000 MG IV QD (Number of Doses Required (approximate): 2), COLACE (DOCUSATE SODIUM) 100 MG PO BID, ENALAPRIL (ENALAPRIL MALEATE) 2.5 MG PO QD, PERCOCET 1-2 TAB PO Q4H PRN pain, ZOCOR (SIMVASTATIN) 5 MG PO QHS Food/Drug Interaction Instruction Avoid grapefruit unless MD instructs otherwise., ISOSORBIDE MONONITRATE 30 MG PO QD Food/Drug Interaction Instruction Give on an empty stomach (give 1hr before or 2hr after food) (Number of Doses Required (approximate): 15), and NEXIUM (ESOMEPRAZOLE) 20 MG PO QD. Discharge instructions included IV Abx, D/C home with services for QD CTX dosing, IV long line placement, re-admission for removal of infected hardware and spacer placement 9/24/01, and IV Ceftriaxone per VNA 2 Gr IV QD for 10/9/01. Return immediately for increasing temps/shaking chills/pain at R hip. Discharge condition was stable. Follow-up appointment(s) included Dr Lobato 9/24/01, VH pre-admit for OR I&D/removal hardware. 9/24/01 scheduled, and Return to Work after eval by Dr Ashurst. Allergy: Shellfish, Morph
|
What is her current dose of isosorbide mononitrate
|
{
"answer_end": [
1672
],
"answer_start": [
1628
],
"text": [
"ISOSORBIDE MONONITRATE 30 MG PO QD Food/Drug"
]
}
|
Ms. Fought is a 50-year-old female with a history of bipolar disorder, schizophrenia, obstructive sleep apnea, hypertension, and diabetes who presented with right knee swelling, redness, and pain and was admitted to the Emergency Department. She was given therapeutic doses of heparin because of the concern of pain, as well as IV fluids, Oxycodone 5 mg to 10 mg p.o. q.4h. p.r.n. pain, Tylenol 650 mg p.o. q.4h. p.r.n. pain, Ibuprofen 600 mg q.6h. p.r.n. pain, Klonopin 1 mg p.o. at bedtime, Levofloxacin 500 mg p.o. daily for six days after the day of discharge, and NSAIDs, and was prescribed Lisinopril 10 mg daily, Lipitor 40 mg daily, Klonopin, MetroGel p.o. at bedtime, Lithium 900 mg at bedtime, Acebutolol 200 mg daily, and Risperdal 0.5 mg at bedtime, with no known drug allergies. She responded well to normal saline fluid boluses for a total of 3 liters over her hospital course, and was treated with Unasyn and vancomycin, and then switched to levofloxacin, with six more days after discharge from the hospital. Her bradycardia was resolved either over beta blockade or lithium toxicity, for which her beta-blocker was held and her lithium was also held, resulting in an improved heart rate in the 50s and 60s. Upon discharge, she was given instructions to draw blood for lithium level checks daily until it is below 0.5, at which time, she should be restarted on lithium 300 mg p.o. at bedtime, and to follow up with her primary care physician, Dr. Aurelio Gilberto Hencheck at Li County Hospital.
|
has the patient used lisinopril in the past
|
{
"answer_end": [
619
],
"answer_start": [
596
],
"text": [
"Lisinopril 10 mg daily,"
]
}
|
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.
|
What is the dosage of maalox-tablets quick dissolve/chewable
|
{
"answer_end": [
1030
],
"answer_start": [
958
],
"text": [
"Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach,"
]
}
|
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 acetylsalicylic acid
|
{
"answer_end": [
286
],
"answer_start": [
232
],
"text": [
"Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17),"
]
}
|
The patient is a 60 year-old woman with adult onset diabetes mellitus, hypertension, and elevated cholesterol admitted with chest pain, bradycardia, and decreased blood pressure. When her blood pressure is elevated, she takes Nifedipine and the pain became three to four out of ten, so she took Cardizem without relief and called EMS. The pain was relieved with the EMTs gave nitroglycerin times two and they found her to have blood pressure of 190/100, heart rate 76, and normal sinus rhythm. They gave two nitrospray, blood pressure decreased to 150/80, heart rate 76, and after two minutes in the vehicle, she had sinus bradycardia at 30-40, blood pressure 120/80. She was given 0.5 mg of Atropine times one without any affect and brought to the hospital with a systolic blood pressure of 100, then suddenly she had bradycardia with heart rate of 30-40 and systolic blood pressure of 75. She was given intravenous fluids and Atropine 0.5 mg times one which increased her blood pressure systolic to 100 and her heart rate increased to 60. On admission, she was given Nifedipine 10 mg p.r.n. for elevated blood pressure, Lasix 20 mg q. day, Glucotrol 15 mg q. day, Cardizem 300 mg q. day, Coumadin 3.75 mg q. day, Colace 100 mg b.i.d., and Iron 325 mg q. day. On discharge, she was given Aspirin 325 mg q. day, Atenolol 50 mg q. day, Lisinopril 10 mg q. day, Pravachol 20 mg q. day, Glucotrol XL 15 mg q. AM, Lasix 20 mg q. day, and Nitroglycerin tablets sublingual p.r.n. chest pain. She underwent exercise tolerance test on a standard Bruce protocol and angiography which showed left main OK, LAD proximal 20%, D2 60%, ostial 90% mid, left circumflex mid 30%, OM2 distal 60-70%, OM1 mild diffuse disease. She underwent PTCA of her diagonal two which went from 90% to 0% stenosis and she received Heparin overnight and the sheaths were pulled on the following day. She is to follow-up in the VERAREA UNIVERSITY HOSPITAL Clinic with Dr. Van Rothenberg.
|
Has this patient ever been on lasix
|
{
"answer_end": [
1141
],
"answer_start": [
1122
],
"text": [
"Lasix 20 mg q. day,"
]
}
|
Patient Scotty P. Orpen, a 76 year-old female with a history of MI (1984), PVD, CVA, DVT, and supraglottic laryngeal SCC who underwent XRT in 2002, presented to the ED with "stabbing pins" CP which initially started next to the L breast in the midaxillary line that radiated to her breast, sternum, neck, and back around to the L midaxillary line. The patient was given ASA, NTG (partial relief, but dropped BP), heparin bolus & cont infusion, FAMOTIDINE 20 MG PO BID, LASIX (FUROSEMIDE) 80 MG PO QD, MOTRIN (IBUPROFEN) 300 MG PO Q6H, ZOCOR (SIMVASTATIN) 20 MG PO QHS, ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, and MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach. The patient was also instructed to take the syrup form of MOTRIN with food, and to avoid grapefruit with ZOCOR unless otherwise instructed by the MD. The patient was given a low cholesterol/low saturated fat diet and a 2 gram sodium diet, and instructed to resume regular exercise. The rib film preliminary read was without fracture but did have some loss of height of vertebral bodies suggestive of compression fractures which she was treated with Motrin for muscular pain. The suspicion for CHF and PE was low and no anticoagulation was given, and she was ruled out for MI while in the house. Her pain was thought to be musculoskeletal in origin and was treated with NSAIDS. The patient was discharged with instructions to follow up with Dr. Haddow within 1 week of discharge, to call for an appointment, and to continue to take all of her medications as directed.
|
What is the current dose of maalox-tablets quick dissolve/chewable
|
{
"answer_end": [
694
],
"answer_start": [
618
],
"text": [
"and MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach."
]
}
|
Mrs. Trudell, a 69-year-old woman with a history of coronary artery disease and a prior infarction in March 1996, presented to the emergency department at 3:00 a.m. with substernal chest pain and nausea. She took two sublingual nitroglycerin with resolution of the pain by 4:00 a.m. On admission, her medications included simvastatin 10 mg q.h.s., sublingual nitroglycerin, enalapril 5 mg b.i.d., aspirin 325 mg q.d., and Atenolol 50 mg b.i.d. Her heart rate and blood pressure were controlled with intravenous medications and she was managed medically until hospital day three when she was taken of the cardiac catheterization laboratory. Cardiac catheterization revealed a 90% plus left anterior descending artery lesion distal to D1 with evidence of thrombus, 60% proximal left circumflex lesion with diffuse disease in the OM1, and a 40% right coronary artery lesion. She underwent PTCA and stenting of her left anterior descending artery lesion followed by ReoPro infusion. Electrocardiogram abnormalities had resolved and cardiac enzymes returned to baseline. On discharge, the patient was instructed to resume a low fat, low cholesterol diet and to take aspirin 325 mg p.o. q.d., simvastatin 10 mg p.o. q.h.s., Ticlid 250 mg p.o. b.i.d. for 11 days, Atenolol 25 mg p.o. b.i.d., and enalapril 20 mg p.o. q.d. She had follow-up with Dr. Kroell and Dr. Brendlinger at a later date.
|
When was the last time that the patient received ticlid
|
{
"answer_end": [
1314
],
"answer_start": [
1218
],
"text": [
"Ticlid 250 mg p.o. b.i.d. for 11 days, Atenolol 25 mg p.o. b.i.d., and enalapril 20 mg p.o. q.d."
]
}
|
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic.
|
atrial fibrillation meds on in past
|
{
"answer_end": [
451
],
"answer_start": [
404
],
"text": [
"She was then started on amiodarone and Coumadin"
]
}
|
75 yo Spanish speaking F was admitted for pre-syncope and discharged on 9/15/04 with full code status to home with medications including TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS with food/drug interaction instruction to avoid grapefruit unless MD instructs otherwise and IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD with food/drug interaction instruction to give on an empty stomach (give 1hr before or 2hr after food) and ZANTAC (RANITIDINE HCL) 150 MG PO BID and CELEBREX (CELECOXIB) 200 MG PO QD with food/drug interaction instruction to take with food with diet of house/low chol/low sat. fat and activity of walking as tolerated. An EKG showed sinus brady and a TSH test was mildly elevated at 5.3. Labs showed an elevated LDL, cardiac enzymes negative, UA negative, Hct 40 at baseline, and an aMIBI 3/24 showed a small reversible defect of mild intensity in the distal ant wall and apex c/w small area ischemia in the distal LAD. The patient was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS on order for ZOCOR PO (ref # 63128567), IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD, ZANTAC (RANITIDINE HCL) 150 MG PO BID, CELEBREX (CELECOXIB) 200 MG PO QD, NSAIDS, and LOVENOX for DVT ppx. The patient was advised of the benefits of ASA for her and was started on 81mg qd and may benefit from EGD as well as increasing Imdur if persistent hypertension. It is important to call Dr. Mcquade for a follow up appointment within the next 1-2 weeks and to take all medications on the discharge list at the doses specified. The patient presents with pre-syncope, hypothyroidism, asthma, left hip pain, headache and polyarthralgias. The patient was monitored on tele and the atenolol could be a contributing factor to the bradycardia and was switched to bid frequency with 1/2 dose (25mg). GI symptoms include dyspepsia and was started on PPI and checked for H.pylori. Endocrine symptoms included a mildly subtherapeutic levoxyl which was increased to 75mcg qd. Pulmonary symptoms included asthma which was continued on albuterol inhaler PRN and DVT ppx with Lovenox. MSK symptoms included trochanteric bursitis which was treated with Tylenol.
|
Is the patient currently or have they ever taken levoxyl
|
{
"answer_end": [
2394
],
"answer_start": [
2283
],
"text": [
"Endocrine symptoms included a mildly subtherapeutic levoxyl which was increased to 75mcg qd. Pulmonary symptoms"
]
}
|
Mr. Almon is a 51 year old gentleman with history of insulin dependent diabetes mellitus and unstable angina who was doing yard work and experienced an episode of nausea and vomiting along with chest discomfort. His EKG was noted to have an old T wave inversion in lead 3 which was now upright and ST depressions that were normalizing, along with CKs of 974 and MB 24.3 and Troponin level of 1.77. He received aspirin 5 mg of intravenous Lopressor, Heparin drip and Adenosine MIBI. Cardiac catheterization revealed Right dominant system, no significant left main lesions identified, left anterior descending coronary artery with a discreet mid 65% lesion, distal 99% lesion and first diagonal coronary artery with a proximal discrete 70% lesion, left circumflex coronary artery with a distal after the second obtuse marginal discrete 60% lesion, supplying the second obtuse marginal. First marginal coronary artery had an ostial discrete 90% lesion and a second obtuse marginal had an ostial discrete 100% lesion. Right coronary artery had a mid discrete 95% lesion supplying the right posterior descending coronary artery. The patient underwent echocardiogram which revealed mild concentric left ventricular hypertrophy with normal cavity size and left ventricular systolic function mildly reduced with an estimated ejection fraction of 45%, severe hypokinesis of the basal and mid segments of the inferior wall and inferior septum, and severe hypokinesis of the posterior wall, apex and distal anterior wall. He underwent coronary artery bypass graft x 3 with a left internal mammary artery to left anterior descending artery, saphenous vein graft to the obtuse marginal coronary artery and saphenous vein graft to the intermediate coronary artery. Postoperatively, he was extubated on postoperative day number one and transferred to the step down unit, with a T.max of 99. He had serous drainage from the inferior aspect of his sternal incision. He was started on Keflex 500 mg four times a day for 10 days. Discharge medications included Enteric coated aspirin 325 mg once a day, ibuprofen 200 to 800 mg every 4 to 6 h p.r.n. pain, NPH Humulin insulin 44 units in the morning, 14 units in the evening, regular insulin 6 units twice a day, Niferex 150 mg twice a day, potassium chloride 20 mEq once a day, Zocor 40 mg once in the evening, Atenolol 50 mg once a day, Lisinopril 10 mg once a day, Keflex 500 mg four times a day for 10 days for his superficial sternal wound infection and torsemide 60 mg twice a day, and he was discharged to home in stable condition.
|
What his superficial sternal wound infection meds has vet tried in past
|
{
"answer_end": [
2440
],
"answer_start": [
2342
],
"text": [
"Atenolol 50 mg once a day, Lisinopril 10 mg once a day, Keflex 500 mg four times a day for 10 days"
]
}
|
Logan Czaplinski, an 833-08-42-8 patient, was admitted on 1/27/2001 and discharged on 5/18/2001 to his home with a prescription of ASA (Acetylsalicylic Acid) 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lasix (Furosemide) 80 MG PO BID, Ativan (Lorazepam) 1 MG PO BID PRN anxiety or insomnia, Lopressor (Metoprolol Tartrate) 12.5 MG PO BID, Thiamine (Thiamine HCl) 100 MG PO QD, Coumadin (Warfarin Sodium) 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), Insulin 70/30 (Human) 30 units SC BID, Imdur (Isosorbide Mononit.(SR)) 60 MG PO QD, KCL Slow Rel. 20 mEq x 1 PO BID, Allegra (Fexofenadine HCl) 60 MG PO QD, and Levofloxacin 250 MG PO QD Starting in AM (7/21). An override was added on 10/10/01 by Kent R. Kazee, MD with Potentially Serious Interactions: Aspirin & Warfarin, Simvastatin & Warfarin, and Levofloxacin & Warfarin. Food/Drug Interaction Instructions were also given. This 60-year-old male patient with ischemic CMP and AFib was started on Coumadin 5 weeks ago and was cardioverted via the AICD last Tuesday. He then developed SOB and fever, so he went to the local ED and was given Lasix and Rocephin. His WBC was elevated at 12.2 and he was sent to LMH where he had a low grade fever and required FM O2. He was treated empirically with Levofloxacin, diuresed, and assessed for underlying rhythm. His CXR showed interval improvement and his BCXs from LWMH were negative at 3 days. He was discharged on PO diuretics and a 14-day course of Levofloxacin, with ASA 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lopressor 12.5 MG PO BID, Thiamine 100 MG PO QD, Coumadin 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), and Ativan 1 MG PO BID PRN anxiety or insomnia. He should seek immediate medical attention if he develops chest pain, SOB, lightheadedness, fever, chills, palpitations, or falls.
|
Is there a mention of of coumadin ( warfarin sodium ) usage/prescription in the record
|
{
"answer_end": [
457
],
"answer_start": [
418
],
"text": [
"Coumadin (Warfarin Sodium) 5 MG PO QHS,"
]
}
|
The patient is an 83-year-old female with a history of coronary artery bypass grafting (CABG) in 1993, a left main and diagonal percutaneous transluminal coronary angioplasty (PTCA) with cypher stent, and a bare metal stent in the diagonal for recurrent chest pain. She was admitted for possible myocardial infarction due to anginal pain, however 3 sets of negative cardiac enzymes and no EKG changes ruled this out. She woke up at 5am with substernal epigastric pain, which was unclear if it was angina or esophageal spasm. She took Maalox and 3 nitroglycerin (NTG) with pain that responded to nitro, blood pressure (BP) dropped 140s to 90s but came right back. Admitted medications included ECOTRIN (Aspirin Enteric Coated) 325 mg PO QD, Atenolol 50 mg PO QD, Ferro-Sequels 1 tab PO QD, Lisinopril 30 mg PO QD, Pravachol (Pravastatin) 80 mg PO QHS, Norvasc (Amlodipine) 5 mg PO QD, Imdur ER (Isosorbide Mononitrate (SR)) 120 mg PO QD, Pilocarpine 2% 1 drop OU BID, Bactrim DS (Trimethoprim/Sulfamethoxazole Double Strength) 1 tab PO BID x 12 doses starting today (10/19), Clobetasol Propionate 0.05% Cream TP BID, Allegra (Fexofenadine HCL) 60 mg PO QD, on order for Allegra PO (ref #483093734), Alphagan (Brimonidine Tartrate) 1 drop OU BID, Plavix (Clopidogrel) 75 mg PO QD, Calcium Carbonate 1,500 mg (600 mg elem Ca)/Vit D 200 IU 1 tab PO QD, Zetia (Ezetimibe) 10 mg PO QD, Metformin 250 mg PO BID, Aciphex (Rabeprazole) 20 mg PO QD, and Plavix, BB, ACE, statin, Zetia. Lipid panel was good with total cholesterol 163 and LDL 86 HDL 43. ACE was uptitrated to optimize BP, increased to 30 mg daily with improved BP with SBP in 110s. The patient had a history of anemia and was continued on iron. HCT was stable in low 30s, 32.6 at discharge. The patient was started on Bactrim for 7 days for a urinary tract infection. All other medications were the same. The patient was discharged in stable condition with instructions to monitor BP with uptitration of ACE, take calcium, follow a cardiac and diabetic diet, watch calcium, and take Lovenox and PPI.
|
Has this patient ever been on ecotrin ( aspirin enteric coated )
|
{
"answer_end": [
739
],
"answer_start": [
693
],
"text": [
"ECOTRIN (Aspirin Enteric Coated) 325 mg PO QD,"
]
}
|
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 had previous lasix ( furosemide )
|
{
"answer_end": [
869
],
"answer_start": [
838
],
"text": [
"LASIX (FUROSEMIDE) 40 MG PO QD,"
]
}
|
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 combivent ( ipratropium and albuterol sulfate )
|
{
"answer_end": [
1572
],
"answer_start": [
1511
],
"text": [
"Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID."
]
}
|
The patient is a 75-year-old female with a history of 2. Diabetes , on insulin, congestive heart failure, bilateral occipital CVAs, hypertension, chronic renal insufficiency, coronary artery disease, visual impair with tunnel vision, monoclonal gammopathy, and left upper extremity thrombophlebitis. She was found at home with altered mental status and a fingerstick of 37, which increased to 42 with orange juice and normalized her mental status. She was given 1. Lasix 80 mg p.o q.d. in the morning , 40 mg p.o. q.d. in the evening, 2. Atenolol 75 mg p.o. q.d., 3. Lipitor 10 mg p.o. q.d., 4. Amitriptyline 25 to 50 mg p.o. q.h.s. p.r.n., 5. Multivitamins., 6. Aspirin 325 mg p.o. q.d., 7. Folate 100 mg p.o. q.d., 8. Lisinopril 20 mg p.o. q.d., 9. Iron gluconate 325 mg p.o. t.i.d., 10. Novolin 34 to 40 units subcu. q.d., 11. Epogen 5000 units subcu. q. week., 6. Aspirin 325 mg p.o. q.d., 7. Colace 100 mg p.o. b.i.d., and 2. Metoprolol 12.5 mg p.o. b.i.d. Her NPH dose was cut to 20 units subcu. q.d. with lispro sliding scale q.a.c. and q.h.s., and Metoprolol was changed to Toprol as her blood pressure tolerates. Lisinopril was switched to captopril, then discontinued given her bumping which might suggest thalassemia. She is on iron and Epogen with Prophylaxis: Heparin and H2 blocker. Her minimally needed insulin was 5 units a day and her sugars were well controlled otherwise low. Lasix was decreased to 80 mg p.o. b.i.d. and the x-ray on the day of her discharge showed it was unlikely consolidated lobar pneumonia because of the improved forward flow from discontinuation of her ACE inhibitor. She was admitted with hypoglycemic diabetes possibly secondary to infection or logistical and social barriers, and was treated initially with levofloxacin for her right lower lobe pneumonia versus CHF, pleural effusion which decreased only minimally with diuresis of 1 to 2 liters overnight and for diagnostic and therapeutic purposes she underwent a thoracentesis on 2/11/05. Her chronic renal insufficiency was noted with creatinine at baseline of 2.6 and it decreased significantly on this admission possibly because of improved forward flow from discontinuation of her ACE inhibitor. She was on iron and Epogen with an improved hematocrit from the prior admission but no change in her MCV which suggests that she has more than renal disease causing her microcytosis. Her diabetc diet was low sodium, low fat, low cholesterol and prophylaxis included Heparin and H2 blocker. Her discharge medications included 1. Lasix 80 mg p.o. b.i.d., 2. Metoprolol 12.5 mg p.o. b.i.d., 3. Lipitor 10 mg p.o. q.d., 4. Amitriptyline 25 to 50 mg p.o. q.h.s. p.r.n., 5. Multivitamins, 6. Aspirin 325 mg p.o. q.d., 7. Folate 100 mg p.o. q.d., 8. Lisinopril 20 mg p.o. q.d., 9. Iron gluconate 325 mg p.o. t.i.d., and 10. Epogen 5000 units subcu. q. week. She was screened for admission to Jack Nor Medical Center Of where she will go today with intense physical therapy and learning greater independence in her daily functioning. Her pelvic films were negative for fracture. She should be ambulated t.i.d. with follow up with Dr. Rufener when she is able, Lasix dose can be increased as needed for better diuresis, and studies pending include cytology and culture of pleural fluid and follow-up chest x-ray on the day of her discharge.
|
Has this patient ever been prescribed insulin
|
{
"answer_end": [
447
],
"answer_start": [
401
],
"text": [
"orange juice and normalized her mental status."
]
}
|
The patient was admitted on 5/5/2006 with a history of mechanical fall, with the attending physician being Dr. Clemente Armand Bolstad, with a full code status and disposition of Rehabilitation. Medications on Admission included Amiodarone 100 QD, Colace 100 bid, lasix 40mg QD, Glyburide 5mg bid, Plaquenil 200mg bid, Isordil 20mg tid, Lisinopril 20mg QD, Coumadin 5mg 3dys/week, 2.5mg 4dys/week, Norvasc 10mg QD, Neurontin 300mg TID, with APAP prn. An override was added on 10/2/06 by Gerad E. Dancy, PA for POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & WARFARIN with the reason for override being monitoring. The patient was rehydrated with IVF and PO's were encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable dose. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache. A CT pelvis showed a right adnexal cyst which will need further characterization by US and outpatient follow up. The patient has an extensive cardiac history and the fall is not likely related to a cardiac issue as it appears mechanical, with no syncope, chest pain, etc. She was diagnosed with an NSTEMI with a small TnI leak, likely demand related in the setting of hypovolemia and the fall. Enzymes trended down. She was dry on admission and rehydrated with IVF, PO's encouraged, and became euvolemic by 1/2. Her JVP was up to 12cm, although it was difficult to gauge her volume status due to TR. She had a prolonged QT on admission, on telemetry, of unclear etiology, possibly starvation. This was monitored on telemetry until ROMI and drugs that confound were avoided. The QTc resolved to low 500s and a DDD pacer was functioning with V-pacing at 60bpm. Additional medications included NATURAL TEARS (ARTIFICIAL TEARS) 2 DROP OU BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, PLAQUENIL SULFATE (HYDROXYCHLOROQUINE) 200 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP <110, MILK OF MAGNESIA (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO DAILY PRN Constipation, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM, NORVASC (AMLODIPINE) 10 MG PO DAILY HOLD IF: SBP <110, NEURONTIN (GABAPENTIN) 300 MG PO TID, NEXIUM (ESOMEPRAZOLE) 20 MG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, DULCOLAX RECTAL (BISACODYL RECTAL) 10 MG PR DAILY PRN Constipation, CLOTRIMAZOLE 1% TOPICAL TOPICAL TP BID, GLYBURIDE 5 MG PO BID, LASIX (FUROSEMIDE) 20 MG PO DAILY, and corrected pt restarted on lasix 20 qd on d/c. A PT consult was obtained 3/21 and to follow daily at rehab. Labs showed Na 146, CK 3320, CKMB 12.9, Trop 0.23--->0.10, AST 107, Cr 1.2-->1.6. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache, rehydrated with IVF, po's encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable
|
How often does the patient take coumadin ( warfarin sodium )
|
{
"answer_end": [
2228
],
"answer_start": [
2187
],
"text": [
"COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM,"
]
}
|
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