Transcript Working Together In EMS 2002

HOME MEDICATIONS
Bryan Bledsoe, DO, FACEP, EMT-P
Corporate Sponsors
Home Medications
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A patient’s medications can provide a
tremendous amount of information
regarding the patient’s underlying
medical problems.
Top-Ten Prescriptions in 2001
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1. Hydrocodone/APAP
2. Lipitor
3. Premarin
4. Synthroid
5. Atenolol
6. Furosemide
7. Prilosec
8. Albuterol
9. Norvasc
10. Alprazolam
Mrs. Helen McCurdy
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76 year old female found unresponsive
by rural postal carrier. No family or
friends around.
Vital Signs:
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Blood Pressure: 138/90 mmHg
Heart Rate: 102 bpm
Respirations: 10 per minute
Mrs. Helen McCurdy
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Medications found in cupboard:
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Lanoxin
Lasix
Vasotec
Ismo
K-Dur
Keflex
MS-Contin
Mrs. Helen McCurdy
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Medications found in cupboard:
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Lanoxin: CHF, atrial fibrillation
Lasix: CHF, HTN
Vasotec: CHF, HTN
Ismo: Angina
K-Dur: Potassium Depletion
Keflex: Infection
MS-Contin: Pain
Mrs. Helen McCurdy
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Upon evaluation at Sundown ED:
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1. Lacunar stroke due to HTN and AF
2. CHF (mild exacerbation)
3. Atrial Fibrillation
4. Stable angina pectoris
5. Moderate HTN (fair control)
6. Chronic sciatica due to degenerative disc
disease
7. Recent sinus infection
Home Medication Packaging
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Shoe Box
Paper Grocery Bag (Sack)
K-Mart Plastic Bag
Wal-Mart Plastic Bag
Pill holder bought by caring family
member which sorts pills by time and
date (with no labels whatsoever)
What medicines do you take?
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Well, I take a little pink pill in the
morning and two of the white pills in
the evening.
Oh honey…I don’t know. You better call
Dr. Williams. He keeps up with all of
my medications.
Oxy-Contin….and I NEED MORE!!!
Definitions
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Drugs are chemical agents used in the
diagnosis, treatment, or prevention of
disease.
Medication Classes
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Analgesics
Antianginals
Anxiolytics
Anticoagulants
Anticonvulsants
Antidepressants
Antidiabetic
Antihypertensives
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Antipsychotics
Beta-Blockers
Bronchodilators
Calcium Channel
Blockers
Cardiotonics
Diuretics
Sedatives/Hypnotics
Analgesics
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Used to alleviate pain and inflammation
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Narcotics
Non-Steroidal Anti-Inflammatory Agents
Non-Narcotic/Non-NSAIDs
Anti-Migraine Agents
Narcotic Analgesics
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Used to treat
moderate to severe
pain
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Morphine
Codeine
Vicodin
Lorcet
Darvocet
Lortabs
Percocet
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Percodan
Oxy-Contin
MS Contin
Stadol NS
Dilaudid
Demerol
Talwin
Norco
Fentanyl
NSAIDs
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Alleviate pain and
inflammation
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Motrin
Toradol
Naprosyn
Anaprox
Celebrex
Lodine
Relafen
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Tolectin
Vioxx
Voltaren
Non-Narcotic/Non-NSAID
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Mild-moderate pain
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Acetaminophen
Ultram
Topicals
Anti-Migraine
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Used to treat
headache in
documented
migraineurs
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Inderal
DHE
Midrin
Amerge
Axert
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Imitrex
Maxalt
Zomig
Anti-Anginals
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Used in the treatment of angina
pectoris
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Nitroglycerin
Ismo
Isordil
Cardizem
Antihypertensives
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Used to decrease blood pressure
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Adrenergic blockers
ACE Inhibitors
Angiotensin II Receptor Antagonists
Beta-Blockers
Calcium-Channel Blockers
Diuretics
Vasodilators
Combination Agents
Adrenergic Blockers
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Cause peripheral vasodilation
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Cardura
Hytrin
Normodyne
ACE Inhibitors
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Cause peripheral vasodilation
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Accupril
Altace
Captopril
Lotensin
Monopril
Prinivil
Univasc
Vasotec
Zestorectic
Angiotensin II Receptor
Antagonists
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Cause peripheral vosodilation
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Atacand
Avapro
Cozaar
Diovan
Beta Blockers
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Decrease heart rate and cause peripheral
vasodilation
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Betapace
Blocadren
Corgard
Inderal
Sectral
Tenormin
Toprol
Calcium-Channel Blockers
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Cause peripheral vasodilation and slow AV
conduction
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Adalat
Cardene
Cardizem
DynaCirc
Isoptin
Norvasc
Procardia
Diuretics
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Cause water excretion decreasing
circulating volume
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Dyazide
Maxzide
Demedex
Lasix
Diuril
Zaroxolyn
Vasodilators
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Decrease peripheral vasodilation (many
agents indirectly cause this affect)
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Nitrates
Calcium Channel Blockers
ACE Inhibitors
Combination Agents
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Usually a combination of two
antihypertensive agents
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Monopril HCT
Prinizide
Zestoretic
Hyzaar
Antiarrhythmics
Corrects cardiac dysrhythmias
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I.
II.
III.
IV.
Mexitil, Quinidex, Rhythmol, Tambocor
Betapace, Brevibloc, Inderal
Cordarone, Corvert
Cardizem, Isoptin
Digoxin commonly used to control rate.
Antilipidemics
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Lowers blood lipids (cholesterol)
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Lopid
Baycol
Lescol
Lipitor
Mevacor
Pravachol
Zocor
Alzheimer’s Agents
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Helps manage s/s Alzheimer’s dosease
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Aricept
Cognex
Reminyl
Anticonvulsants
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Used to prevent seizures
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Nembutal
Neurontin
Depakote
Tegretol
Dilantin
Lamictal
Zaorntin
Antidiabetic Agents
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Used to lower blood sugar in diabetes
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Insulin
Glucophage
Glycet
Precose
Diabeta
Glucotrol
Antibiotics
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Used to treat infections (primarily
bacterial)
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Cephalosporins
Macrolides
Penicillins
Quinolones
Sulfonamides
Tetracyclines
Cephalosporins
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Keflex
Ceclor
Cedax
Ceftin
Duricef
Suprax
Macrolides
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Erythromycin
Biaxin
Zithromax
Penicillins
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Common
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Beta-Lactam
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Amoxicillin
Penn VK
Augmentin
Gorrilacillins
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Unasyn
Zosyn
Quinolones
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Cipro
Floxin
Levaquin
Noroxin
Trovan
Sulfonamides
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Bactrim
Septra
Tetracyclines
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Tetracycline
Doryx
Minocin
Vibramycin
HIV/AIDS Agents
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Reverse transcriptase inhibitors
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Rescriptor
Viramune
Combivir
Epivir
Retrovir
Videx
Zerit
HIV/AIDS Agents
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Protease Inhibitors
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Agenerase
Fortovase
Norvir
Viracept
Anti-Viral Agents
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Inhibit viral growth/reproduction
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Famvir
Flumadine
Symmetrel
Valtrex
Zovirax
Anti-Parkinsonian
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Helps minimize the symptoms of Parkinson’s
disease
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Akineton
Artane
Benadryl
Levsin
Lodosyn
Mirapex
Requip
Sinnemet
Symmetrel
Blood Modifiers
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Decrease blood clotting and viscosity
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Coumadin
Persantine
Aggrastat
Plavix
Ticlid
Gastrointestinal Agents
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Antacids
Anticholinergics
Antidiarrheals
Antiemetics
Antispasmodics
Laxatives
Anti-Ulcer Agents
Antacids
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Decrease gastric acid levels
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Calcium antacids
Magnesium antacids
Anticholinergics
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Decreases gastric acidity and motility
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Robinul
Levsin
Antidiarrheals
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Slow GI motility and increase stool bulk
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Immodium A-D
Pepto-Bismol
Antiemetics
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Decreases nausea and vomiting
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Compazine
Phenergan
Tigan
Zofran
Reglan
Anti-spasmotics
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Decreases GI motility and spasm
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Donnatal
Levsin
Bentyl
Laxatives
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Evacuates bowels
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Magnesium citrate
Colace
Senokot
Anti-Ulcer Agents
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Decrease gastric acid, promote ulcer
healing
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Prilosec
Prevacid
Aciphex
Zantac
Pepcid
Hormones
Substances secreted by ductless
glands that control other glands
and body functions
Hormones
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How do you make a hormone?
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Don’t pay her!
Hormones
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Estrogens
Glucocorticoids
Progesterone
Thyroid Replacements
Testosterone
Estrogens
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Naturally-occurring female hormone
used to replace natural hormone
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Estrace
Ogen
Premarin
Glucocorticoids
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Used to reduce inflammation and the
immune response
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Prednisone
Pediapred
Prelone
Medrol
Decadron
Cortisone
Progesterone
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Naturally-occurring female hormone
used to replace natural hormone
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Provera
Usually used in combination with
estrogen
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OCPs
Premphase
Thyroid Hormones
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Used to replace defiicient natural
hormone
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Syntrhoid
Levothroid
Testosterone
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Used for selected cases of impotence
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Testroderm
Testred
Anti-Depressants
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Used to treat depression and other
affective disorders
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MAOIs
SSRIs
TCAs
Miscellaneous Agents
Monamine Oxidase Inhibitors
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Increases amount of dopamine by
decreasing MAO
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Nardil
Parnate
There are many potential problems with
patients on MAOIs and these should be a
red flag.
Selective Serotonin Reuptake
Inhibitors (SSRI)
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Increases brain levels of dopamine
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Celexa
Paxil
Prozac
Zoloft
Tricyclic Antidepressants
(TCAs)
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Increases levels of dopamine in the
brain
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Etrafon
Limbitrol
Norpramin
Sinaqual
Elavil
Miscellaneous Agents
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Various mechanisms
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Effexor
Remeron
Serzone
Wellbutrin
Antipsychotics
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Used to treat various psychotic states (i.e.
schizophrenia)
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Serentil
Thorazine
Haldol
Loxitane
Moban
Navane
Risperdal
Seroquil
Psychotic Patients
Patients with major psychiatric
disorders, such as schizophrenia,
are often non-compliant with
needed medications. Doctors
often prescribe long-acting antipsychotics that can be given
fortnightly or at even longer
intervals (Haldol Decanoate)
Anti-Manic Agents
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Used to control mania in bipolar
disorder
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Lithium
Lithobid
Eskalith
Obsessive-Compulsive
Disorders
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Used to control obsessive/ritualistic
behaviors
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Luvox
Paxil
Prozac
Zoloft
Antianxiety Agents
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Used to treat anxiety, panic disorders,
and similar affective disorders
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Valium
Ativan
Xanax
Librium
Tranxene
Buspar
Sedatives/Hypnotics
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Used to sedate or induce sleep
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Commonly-used benzodiazepines
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Restoril
Halcion
Dalmane
Related-Agents
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Ambien
Sonata
Respiratory Agents
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Used to decrease bronchospasm,
inflammation, and to stimulate
respirations.
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Beta-Agonists
Xanthines
Anti-Inflammatories
Miscellaneous Agents
Beta Agonists
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Cause bronchodiation by blocking beta
2 adrenergic receptors
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Albuterol
Metaproterenol
Isoetharine
Maxair
Serevent
Xanthines
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Cause bronchodilation
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Theophylline
Theo-Dur
Aminophylline
Uniphyl
Anti-Inflammatories
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Decrease inflammation
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Prednisone
Decadron
Aerobid
Azmacort
Flovent
Vanceril
Combivent
Miscellaneous Agents
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Used to augment other agents.
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Atrovent
Intal
Singulair
Accolate
Zyflo
Case Studies
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42 year old female with altered mental
status and dyspnea.
Medications:
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Prednisione
Serevent
Alupent
Augmentin
Case Studies
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24 year old female with altered mental
status and fever.
Medications:
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Bactrim
Retrovir
Viracept
Pentamidine
Case Studies
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72 year old male with chest pain.
Medications:
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NTG
ASA
Prinivil
Lipitor
Persantine
Lanoxin
Coumadin
Glucophage
Case Studies
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56 year old female with altered mental status
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Lanoxin
Diabeta
Vasotec
Synthroid
Betapace
Maxzide
Ventolin