Follow-up Medical History (FH-1)
|
|
|
- Hilary Blankenship
- 7 years ago
- Views:
Transcription
1 9FH126 Jan 10 Citalopram for Agitation in Alzheimer s Disease CitAD (FH-1) Reference #: Purpose: Record the interval medical history. When: At F3, F6, and F9. Completed by: CitAD certified clinician. Instructions: Items should be answered based on the interviewer s assessment of information provided by the patient (or if necessary, by the caregiver). The clinician should complete this form after completing the CGI and NBRS assessments. Any serious adverse events should be recorded on the Safety Report (SR) form. See handbook sections on adverse event reporting and treatment termination guidelines. A. Clinic, patient, and visit identification 1. Clinic ID: 2. Patient ID: C 3. Patient four-letter code: 4. Date form completed: 5. Visit ID: day month year 8. Since the date of the last EH or FH form, has the patient taken medication(s) for Alzheimer s disease (check all that apply): a. None of the below ( 1) b. Memantine (Namenda ) ( 1) c. Donepezil (Aricept ) ( 1) d. Rivastigmine (Exelon ) ( 1) e. Galantamine (Reminyl ) ( 1) f. Other () ( 1) 6. Form revision date: 2 6 day B. Medical history j a month n 1 year 7. Healthcare visits or admissions (Complete SR form for any serious adverse events listed below.) a. Number of hospital admissions (if none, put zero): 0 # of hospitalizations 9. Since the date of the last EH or FH form, has the patient taken lorazepam: Yes ( 1) 10. Since the date of the last EH or FH form, how many was the patient administered lorazepam in the following doses (if none, put zero): a. 0.5 mg/day b. 1.0 mg/day 11. No ( 2) b. Number of surgeries (if none, put zero): c. 1.5 mg/day # of surgeries d. 2.0 mg/day e. Greater than 2.0 mg/day c. Number of other urgent healthcare visits (if none, put zero): # of visits 11. Since the date of the last EH or FH form, has the patient taken trazodone: Yes ( 1) No ( 2) CitAD Form FH 1 of 9
2 Citalopram for Agitation in Alzheimer s Disease Patient ID: C 12. Has the patient had the following since the date of the last EH or FH form (including chronic diseases that were present at previous visits) (check all that apply): a. Hypertension ( 1) b. Myocardial infarction ( 1) c. Congestive heart failure ( 1) d. Arthritis ( 1) e. Diabetes ( 1) f. Stroke ( 1) g. Atrial fibrillation ( 1) h. Asthma ( 1) i. COPD ( 1) j. Epilepsy ( 1) k. Cancer () ( 1) l. Kidney disease () ( 1) m. Liver disease () ( 1) n. GI disease () ( 1) o. Lung disease (not listed above; ) ( 1) p. Other() ( 1) q. Other() ( 1) r. Other() ( 1) s. Other() ( 1) t. Other() ( 1) CitAD Form FH 2 of 9
3 13. Since the date of the last EH or FH form, has the patient had any of the following symptoms (Note that symptoms continue on the next page. Check only one in each subitem): None Mild Moderate Severe a. Abdominal pain... ( 1) ( 2) ( 3) ( 4) b. Anorexia (poor appetite)... ( 1) ( 2) ( 3) ( 4) c. Anxiety... ( 1) ( 2) ( 3) ( 4) d. Asthenia (weakness)... ( 1) ( 2) ( 3) ( 4) e. Bronchitis... ( 1) ( 2) ( 3) ( 4) f. Confusion... ( 1) ( 2) ( 3) ( 4) g. Constipation... ( 1) ( 2) ( 3) ( 4) h. Cough... ( 1) ( 2) ( 3) ( 4) i. Decreased libido... ( 1) ( 2) ( 3) ( 4) j. Diarrhea... ( 1) ( 2) ( 3) ( 4) k. Dizziness... ( 1) ( 2) ( 3) ( 4) l. Drug allergic reaction/hypersensitivity... ( 1) ( 2) ( 3) ( 4) m. Dry mouth... ( 1) ( 2) ( 3) ( 4) n. Ejaculatory dysfunction... ( 1) ( 2) ( 3) ( 4) o. Falls... ( 1) ( 2) ( 3) ( 4) p. Fatigue... ( 1) ( 2) ( 3) ( 4) q. Fever... ( 1) ( 2) ( 3) ( 4) r. Gait instability... ( 1) ( 2) ( 3) ( 4) s. Headache... ( 1) ( 2) ( 3) ( 4) t. Indigestion... ( 1) ( 2) ( 3) ( 4) u. Insomnia... ( 1) ( 2) ( 3) ( 4) v. Joint pain... ( 1) ( 2) ( 3) ( 4) w. Muscle pain... ( 1) ( 2) ( 3) ( 4) x. Nasal congestion... ( 1) ( 2) ( 3) ( 4) y. Nausea... ( 1) ( 2) ( 3) ( 4) z. Nervousness... ( 1) ( 2) ( 3) ( 4) CitAD Form FH 3 of 9
4 14. Symptoms continued: Since the date of the last EH or FH form, has the patient had any of the following symptoms (check only one in each subitem): None Mild Moderate Severe a. Pneumonia... ( 1) ( 2) ( 3) ( 4) b. Rhinitis (runny nose)... ( 1) ( 2) ( 3) ( 4) c. Somnolence (drowsiness)... ( 1) ( 2) ( 3) ( 4) d. Sore throat... ( 1) ( 2) ( 3) ( 4) e. Suicidal thoughts... ( 1) ( 2) ( 3) ( 4) f. Sweating... ( 1) ( 2) ( 3) ( 4) g. Tremor... ( 1) ( 2) ( 3) ( 4) h. Upper respiratory infection (cold)... ( 1) ( 2) ( 3) ( 4) i. Visual disturbances... ( 1) ( 2) ( 3) ( 4) j. Vomiting... ( 1) ( 2) ( 3) ( 4) k. Yawning... ( 1) ( 2) ( 3) ( 4) l. Other 1 ()... ( 1) ( 2) ( 3) ( 4) m. Other 2 ()... ( 1) ( 2) ( 3) ( 4) n. Other 3 ()... ( 1) ( 2) ( 3) ( 4) o. Other 4 ()... ( 1) ( 2) ( 3) ( 4) CitAD Form FH 4 of 9
5 15. Indicate current use of medications not documented on items 8, 9, 10, and 11 of this form. See last page of this form for examples of medication types (check yes or no for each subitem): Yes No a. Non-steroidal anti-inflammatory drugs... ( 1) ( 2) b. Acetaminophen... ( 1) ( 2) c. Aspirin... ( 1) ( 2) d. Histamine H1 receptor antagonists... ( 1) ( 2) e. Histamine H2 receptor antagonists... ( 1) ( 2) f. Proton pump inhibitors... ( 1) ( 2) g. Anticoagulants/antiplatelets... ( 1) ( 2) h. Systemic corticosteroids... ( 1) ( 2) i. Statins (HMG-CoA reductase inhibitors)... ( 1) ( 2) j. Thiazide diuretics... ( 1) ( 2) k. Calcium channel blockers... ( 1) ( 2) l. Beta-blockers... ( 1) ( 2) m. ACE inhibitors... ( 1) ( 2) n. Potassium channel blockers... ( 1) ( 2) o. Anti-diabetic medication... ( 1) ( 2) p. β 2 -adrenergic receptor agonist... ( 1) ( 2) q. Adrenergic agonists... ( 1) ( 2) r. Anti-cholinergics... ( 1) ( 2) s. Vitamins and supplements... ( 1) ( 2) t. Other ()... ( 1) ( 2) u. Other ()... ( 1) ( 2) v. Other ()... ( 1) ( 2) w. Other ()... ( 1) ( 2) x. Other ()... ( 1) ( 2) y. Other ()... ( 1) ( 2) z. Other ()... ( 1) ( 2) CitAD Form FH 5 of 9
6 Citalopram for Agitation in Alzheimer s Disease Patient ID: C C. Physical assessment All measurements are to be taken on the day of the visit. 16. Weight (measured, enter only a or b) a. In pounds: pounds b. In kilograms: kilograms 17. Blood pressure (after sitting for five minutes): a. Systolic: b. Diastolic: 18. Pulse (after sitting for five minutes): mmhg mmhg beats/minute 19. Respirations (after sitting for five minutes): D. Study drug information breaths/minute 20. Since the date of the last EH or FH form, how often has patient taken the prescribed amount of study drug as reported by the patient or caregiver (check only one): Not on study drug ( 1) Never ( 2) Infrequently ( 3) Less than half of the time ( 4) Half of the time ( 5) Most of the time ( 6) Always ( 7) 21. In the opinion of the study staff, how often did the patient take the study drug since the date of the last EH or FH form: (check only one): Not on study drug ( 1) Never ( 2) Infrequently ( 3) Less than half of the time ( 4) Half of the time ( 5) Most of the time ( 6) Always ( 7) 22. Dose prescribed at date of last EH, FH, or TC form: Not on study drug ( 1) 1 capsule ( 2) 2 capsules ( 3) 3 capsules ( 4) 23. Is the dose being changed at this visit: Yes ( 1) 25. No ( 2) 24. Physician recommended dose for the patient (until next visit): Not applicable (visit F9) ( 1) No study drug ( 2) 1 capsule ( 3) 2 capsules ( 4) 3 capsules ( 5) E. Psychosocial intervention 25. Was the psychosocial intervention administered at this visit: Yes ( 1) 26. Duration of psychosocial intervention: F. Respondent 27. Caregiver four-letter code: 27. minutes No ( 2) 28. Was the visit conducted in (check only one): English ( 1) Spanish ( 2) Both English and Spanish ( 3) 29. The information on this form was obtained (check only one): Exclusively from the patient ( 1) Primarily from the patient ( 2) Equally from the patient and the caregiver ( 3) Primarily from the caregiver ( 4) Exclusively from the caregiver ( 5) Other ( 6) CitAD Form FH 6 of 9
7 Citalopram for Agitation in Alzheimer s Disease Patient ID: C G. Administrative information 30. Date form reviewed by study coordinator: day 31. Study coordinator ID: month year 32. Study coordinator signature: 33. Date form reviewed by study physician: day 34. Study physician ID: month year 35. Study physician signature: CitAD Form FH 7 of 9
8 Examples of medication types. This list is to be used as a reference to question 15. Note that while this list includes some examples of medication types, it does not list all examples below that may fall into these categories. a. Non-steroidal anti-inflammatory drugs - celecoxib (Celebrex ) - ibuprofen (Advil, Motrin ) - naproxen (Aleve ) b. Acetaminophen - Tylenol c. Aspirin (i.e., 325 mg, 81 mg, etc) d. Histamine H1 receptor antagonists - diphenhydrochloride (Benadryl ) - loratadine (Claritin ) - fexofenadine hydrochloride (Allegra ) - cetirizine hydrochloride (Zyrtec ) - meclizine (Bonine, Bonamine, Antivert, Postafen ) e. Histamine H2 receptor antagonists - cimetidine (Tagamet ) - famotidine (Pepcid ) - ranitidine (Zantac ) f. Proton pump inhibitors - lansoprazole (Prevacid ) - omeprazole (Prilosec ) g. Anticoagulants/antiplatelets - clopidogrel (Plavix ) - dipyridamole, heparin, ticlopide (Ticlid ) - warfarin (Coumadine ) h. Systemic corticosteroids - betamethasone sodium (Celestone ) - cortisol, cortisone, dexamethasone (Decadron ) - hydrocortisone (Hydracortone ) - methylprednisolone (Solu-Medrol ) - prednisone, prednisolone (Prelone ) i. Statins (HMG-CoA reductase inhibitors) - atorvastatin calcium (Lipitor ) - fluvastatine sodium (Lescol ) - lovastatin (Mevacor ) - pravastatin sodium (Pravachol ) - simvastatin (Zocor ) j. Thiazide diuretics - hydrochlorothiazide (Esidrix, HydroDIURIL ) - hydrochlorothiazide + triamterene (Dyazide ) k. Calcium channel blockers - diltiazem (Cardizem ) - clevidipine (Clevipresx ) - felodipine (Plendil ) - nifedipine (Adalat, Nifedical, and Procardia ) - amlodipine besylate (Norvasc ) - verapamil (Calan ) l. Beta-blockers - atenolol (Tenormin ) - metoprolol (Lopressor ) m. ACE inhibitors - benazepril (Lotensin ) - captopril (Capoten ) - lisinopril (Prinivil, Zestril ) - quinapril (Accupril ) CitAD Form FH 8 of 9
9 n. Potassium channel blockers - amiodarone (Pacerone, Cordarone ) - dofetilide (Tikosyn ) - ibutilide (Corvert ) o. Anti-diabetic medication - insulin, metformin, rosiglitazone (Avandia ) - piolitazone (Actose ) - glimepiride (Amaryl ) - acarbose (Precose ) - exenatide (Byetta ) p. β 2 -adrenergic receptor agonist - salbutamol (Ventolin, Aerolin, Ventorlin, Proventil ) - levalbuterol (Xopenex ) - terbutaline (Brethine, Bricanyl, Brethaire ) - salmeterol q. Adrenergic agonists - epinephrine - ephedrine r. Anti-cholinergics - atropine, ipratropium (Atrovent, Apovent ) - diphenhydramine hydrochloride (Benadryl ) - dimenhydrinate (Dramamine ) - benzatropine (Cogentin ) - tolterodine (Detrol, Detrusitol ) - tiotropium (Spiriva ) s. Vitamins and supplements - vitamin B - vitamin C - vitamin E - vitamin D - calcium - cod liver oil - fish oil - flax seed oil - garlic - ginkgo biloba - zinc CitAD Form FH 9 of 9
Medicines for Heart Disease
Medicines for Heart Disease There are many medicines to treat heart disease. Ask your doctor, nurse or pharmacist if you have questions about your medicines. Take medicines as directed. Do NOT stop taking
Taking Over-the-Counter (OTC) Medicines Safely
Taking Over-the-Counter (OTC) Medicines Safely This chart contains information about some of the more frequent drug interactions that may occur when you are taking over-the-counter (OTC) medicines with
CareATC Generic Formulary Medications Available (2015)
Allergic Reactions EPINEPHRINE** Ephinephrine, EpiPen CETIRIZINE 10MG Zyrtec FEXOFENADINE180MG TABS 100ct Allegra Allergies LORATADINE 10MG Claritin MONTELUKAST 4MG 30CT Singulair PROMETHAZINE 25MG AMP
Full name DOB Age Address Email Phone numbers (H) (W) (C) Emergency contact Phone
DEMOGRAPHIC INFORMATION Full name DOB Age Address Email Phone numbers (H) (W) (C) Emergency contact Phone CARE INFORMATION Primary care physician: Address Phone Fax Referring physician: Specialty Address
Acetylcholinesterase Inhibitors and Memantine Clinical Indication: Treatment of Dementia in Alzheimer s Disease (AD)
SHARED CARE PROTOCOL AND INFORMATION FOR GPS Acetylcholinesterase Inhibitors and Memantine Clinical Indication: Treatment of Dementia in Alzheimer s Disease (AD) Version: 3 Date Approved: June 2011 Review
SAVE ON MEDICAL SERVICES and PRESCRIPTION DRUGS for ongoing conditions
SAVE ON MEDICAL SERVICES and PRESCRIPTION DRUGS for ongoing conditions With Dickinson College s Value Based Insurance Design (VBID) If you have an ongoing condition, you can live well. You will need to
N-methyl-D-aspartate (NMDA) Receptor Antagonist Memantine (CWM TAF ONLY)
Bro Taf Localities Drugs & Therapeutics Committee SHARED CARE Drugs: Acetylcholinesterase inhibitors - Donepezil, Rivastigmine and Galantamine (Cardiff and Vale and Cwm Taf) Protocol No. CV 52 N-methyl-D-aspartate
Presence and extent of fatty liver or other metabolic liver diseases
UC San Diego Health System Patient Information Sheet: Liver Biopsy What is a Liver Biopsy? A liver biopsy is a procedure where a qualified doctor (typically a hepatologist, radiologist or gastroenterologist)
DRUG INTERACTIONS: WHAT YOU SHOULD KNOW. Council on Family Health
DRUG INTERACTIONS: WHAT YOU SHOULD KNOW Council on Family Health Drug Interactions There are more opportunities today than ever before to learn about your health and to take better care of yourself. It
Essential Shared Care Agreement Drugs for Dementia
Ref No. E040 Essential Shared Care Agreement Drugs for Dementia Please complete the following details: Patient s name, address, date of birth Consultant s contact details (p.3) And send One copy to: 1.
Perioperative Medication Management
CARDIOVASCULAR Beta blockers (metoprolol, atenolol, others) Should be continued until and including the day of Ace inhibitors (ACEI) & Angiotensin receptor blockers (ARB) (captopril, lisinopril, losartan,
Emory Eye Center New Patient Questionnaire
Patient Name: Date: Current Address: Current Phone: Date of Birth: Primary Care Physician: Referring Physician: (First & Last Name) (First & Last Name) Pharmacy Name: Phone #: ( ) Please answer all questions
The 365-day period begins with the first dispensing transaction for each Ontario Drug Benefit (ODB) recipient on or after October 1, 2015.
Ontario Public Drug Programs, Ministry of Health and Long-Term Care Chronic-use Medications List by In accordance with subsection 18 (11.1) of Ontario Regulation 201/96 made under the Ontario Drug Benefit
Trinity Clinic Whitehouse Automatic Refill Policy April, 2007
Trinity Clinic Whitehouse Automatic Refill Policy April, 2007 Overview The following pages contain details on how to administer our automatic refill policy. Our intent is to streamline, standardize and
ATRIAL FIBRILLATION IN THE 21 ST CENTURY TIMOTHY DOWLING, D.O. FAMILY PHYSICIAN
ATRIAL FIBRILLATION IN THE 21 ST CENTURY TIMOTHY DOWLING, D.O. FAMILY PHYSICIAN GOALS AND OBJECTIVES At The end of this talk you should understand: What is Atrial Fibrillation Causes of Atrial Fibrillation
Upstate University Health System Medication Exam - Version A
Upstate University Health System Medication Exam - Version A Name: ID Number: Date: Unit: Directions: Please read each question below. Choose the best response for each of the Multiple Choice and Medication
If your drug is not on the list just give us a call for a price. Ask us for details on how to avoid the higher deductible generic price.
If your drug is not on the list just give us a call for a price. Ask us for details on how to avoid the higher deductible generic price. FREE SHIPPING TO AL, CT, DE, FL, GA, IN, KS, MA, MO, MS, NC, NH,
612 Program Midtown Express Pharmacy
ALENDRONATE SOD TAB 35MG (max 1 per week) $37.00 $70.00 ALENDRONATE SOD TAB 70MG (max 1 per week) $37.00 $70.00 ALLOPURINOL TAB 100MG $20.00 $38.00 ALLOPURINOL TAB 300MG $20.00 $38.00 AMITRIPTYLINE TAB
DRUG FOOD INTERACTIONS
ANTIHYPERTENSIVES Natural licorice in large amounts can aggravate high blood pressure and can lower potassium levels. Natural licorice should be avoided with all antihypertensive medications. (Read food
**Form 1: - Consultant Copy** Telephone Number: Fax Number: Email: Author: Dr Bernard Udeze Pharmacist: Claire Ault Date of issue July 2011
Effective Shared Care Agreement for the treatment of Dementia in Alzheimer s Disease Donepezil tablets / orodispersible tablets (Aricept / Aricept Evess ) These forms (1 and 2) are to be completed by both
Harmful Interactions: Mixing Alcohol with Medicines
Harmful Interactions: Mixing Alcohol with Medicines May cause DROWSINESS. ALCOHOL may intensify this effect. USE CARE when operating a car or dangerous machinery. May cause DROWSINESS. ALCOHOL may intensify
Warfarin. (Coumadin, Jantoven ) Taking your medication safely
Warfarin (Coumadin, Jantoven ) Taking your medication safely Welcome This booklet is designed to provide you with important information about warfarin to help you take this medication safely and effectively.
For the Patient: Dasatinib Other names: SPRYCEL
For the Patient: Dasatinib Other names: SPRYCEL Dasatinib (da sa' ti nib) is a drug that is used to treat many types of cancer. It is a tablet that you take by mouth. Tell your doctor if you have ever
To Learn More: Medicines To Help You High Blood Pressure
Medicines To Help You High Blood Pressure Use this guide to help you talk to your doctor, pharmacist, or nurse about your blood pressure medicines. The guide lists all of the FDA-approved products now
MEDICATION GUIDE COUMADIN (COU-ma-din) (warfarin sodium)
MEDICATION GUIDE COUMADIN (COU-ma-din) (warfarin sodium) Read this Medication Guide before you start taking COUMADIN (warfarin sodium) and each time you get a refill. There may be new information. This
Pharmacotherapy of BPSD. Pharmacological interventions. Anti-dementia drugs. Abhilash K. Desai MD Medical Director Alzheimer s Center of Excellence
Pharmacotherapy of BPSD Abhilash K. Desai MD Medical Director Alzheimer s Center of Excellence Pharmacological interventions Reducing medication errors. Reducing potentially inappropriate medication prescription.
PIAX PLUS ASPIRIN 75/100 Film-Coated Tablets contains the active ingredients clopidogrel and aspirin
PIAX PLUS ASPIRIN 75/100 Film-Coated Tablets contains the active ingredients clopidogrel and aspirin Consumer Medicine Information What is in this leaflet This leaflet answers some common questions about
Harmful Interactions: Mixing Alcohol with Medicines
Harmful Interactions: Mixing Alcohol with Medicines. ct. ESS effe SIN this ar ROW nsify a c se D ay inte perating m cau o May OHOL when hinery. ALC CARE us mac USE angero or d U.S. Department of Health
Quiz 4 Arrhythmias summary statistics and question answers
1 Quiz 4 Arrhythmias summary statistics and question answers The correct answers to questions are indicated by *. All students were awarded 2 points for question #2 due to no appropriate responses for
COPD. (Chronic Obstructive Pulmonary Disease) (Emphysema) (Chronic Bronchitis) Education For Our Community
COPD (Chronic Obstructive Pulmonary Disease) (Emphysema) (Chronic Bronchitis) Education For Our Community Chronic Obstructive Pulmonary Disease (COPD) Definition Chronic obstructive pulmonary disease (COPD)
Easy or complex? University Pharmacy. Pharm.D. candidates, 2011
High Blood Pressure Easy or complex? University Pharmacy Edwin Elliot, Insia Hussain Pharm.D. candidates, 2011 The evolution of mankind 2.5 mn years 50 years and we wonder why our healthcare costs are
Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia
Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Version: 3.0 Ratified by: Medicines Committee Date ratified: 16 th November 2011 Name of originator/author: James
ACUTE STROKE UNIT ORIENTATION
ACUTE STROKE UNIT ORIENTATION 2014 TEACHING YOUR STROKE PATIENTS ABOUT THEIR MEDICATION Please refer to Module 8: Secondary Stroke Prevention for additional information Blood Pressure Medication Angiotensin
Blood Pressure Medication. Barbara Pfeifer Diabetes Programs Manager
United Indian Health Services Blood Pressure Medication Titration Program Barbara Pfeifer Diabetes Programs Manager Why a Medication titration program? Despite the many antihypertensive medications available,
ADVICE FOR PATIENTS ON HEART MEDICATIONS
ADVICE FOR PATIENTS ON Contents: Introduction... 2 Drugs that ease chest pain... 4 Drugs that lower blood pressure... 6 Drugs that help an irregular heartbeat... 11 Drugs that lower Cholesterol... 14 Drugs
EMS Information Bulletin- #060
BUREAU OF EMERGENCY MEDICAL SERVICES EMS Information Bulletin- #060 DATE: October 27, 2008 SUBJECT: TO: FROM: Continuous Positive Airway Pressure for Basic Life Support Pennsylvania EMS Organizations &
PREFERRED GENERIC DRUG LIST
These discount programs are NOT health insurance policies and are not intended as a substitute for insurance. The programs do not qualify as a minimum creditable coverage under Massachusetts law or where
Cancer Pain. What is Pain?
Cancer Pain What is Pain? The International Association for the Study of Pain says that pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage." Pain
Member Services A Primary and Urgent Care Concierge Service
Our Medical Membership provides you and your family with medical care within the scope of MDSTAT's Urgent/Primary Care facility. Once active, members can bring their membership card to any MDSTAT clinic
Upper Endoscopy (EGD)
Upper Endoscopy (EGD) Appointment Information: Patient Name: MRN: Physician Name: Location: _ For information on Directions, please visit: http://www.brighamandwomens.org/general/directions/directions.aspx
Medications. Patient Education Pulmonary Rehabilitation. A guide to medications for Chronic Obstructive Pulmonary Disease (COPD) Introduction
Patient Education A guide to medications for Chronic Obstructive Pulmonary Disease (COPD) Do you know how each of your inhalers works to help your breathing? Do you know the correct order in which to use
Medicines To Help You High Blood Pressure
Medicines To Help You High Blood Pressure Use this guide to help you talk to your doctor, pharmacist, or nurse about your blood pressure medicines. The guide lists all of the FDA-approved products now
LISTING OF HERBS/INTERACTIONS
LISTING OF HERBS/INTERACTIONS Capsicum Angiotensin-converting enzyme (ACE) inhibitors used for diabetic kidney disease, heart failure, high blood pressure Theophylline (Elixophyllin, Uniphyl) an asthma
Trileptal (Oxcarbazepine)
Brand and Generic Names: Trileptal Tablets: 150mg, 300mg, 600mg Liquid Suspension: 300mg/5mL Generic name: oxcarbazepine What is Trileptal and what does it treat? Trileptal (Oxcarbazepine) Oxcarbazepine
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT
Nonsteroidal. Drugs (NSAIDs) Anti-Inflammatory. North American Spine Society Public Education Series
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) North American Spine Society Public Education Series Nonsteroidal Anti- Inflammatory Drugs Your healthcare provider has recommended that you take a nonsteroidal
Medication Guide Plavix (PLAV-iks) (clopidogrel bisulfate) tablets
Medication Guide Plavix (PLAV-iks) (clopidogrel bisulfate) tablets Read this Medication Guide before you start taking Plavix and each time you get a refill. There may be new information. This Medication
Community TouchPoint
Community TouchPoint Advice from a Pharmacist: Vitamins, Supplements, and Medication Safety Cassie Spray, PharmD Clinical Pharmacist Kathryn Hauenstein, PharmD PGY1 Community Pharmacy Resident Megan Kline,
Introduction to Atrial Fibrillation (AFib)
Introduction to Atrial Fibrillation (AFib) Learn About: 1. What is atrial fibrillation? 2. How will I feel? 3. Who gets AFib? 4. Risk of stroke 5. AFib treatment 6. How to live well with AFib 1. What is
EXPLORING THE INTERACTION BETWEEN EXERCISE AND MEDICATION FOR CHRONIC DISEASE: CONSIDERATIONS FOR FITNESS PROFESSIONALS
EXPLORING THE INTERACTION BETWEEN EXERCISE AND MEDICATION FOR CHRONIC DISEASE: CONSIDERATIONS FOR FITNESS PROFESSIONALS Steven T. Johnson, PhD 1 Introduction The prevalence of chronic diseases like cardiovascular
Donepezil (Aricept ), Galantamine (Reminyl XL ), Rivastigmine (Exelon ) and Memantine (Ebixa )
Donepezil (Aricept ), Galantamine (Reminyl XL ), Rivastigmine (Exelon ) and Memantine (Ebixa ) ESCA: For the treatment of Alzheimer s disease. SECONDARY CARE SECTION TO BE COMPLETED BY INITIATING DOCTOR
Common Causes of Fluctuating Blood Pressure. When Fluctuating Blood Pressure Readings are Normal
Common Causes of Fluctuating Blood Pressure One in three Americans has high blood pressure. Blood pressure is the measurement of the force of the blood against the walls of the arteries. There are several
Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) is the name for a group of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways
NHS ONEL and NELFT Shared Care Guidelines. Management of medications for Alzheimer s disease. Patient Name : Date of Birth: NHS No:
NHS ONEL and NELFT Shared Care Guidelines Management of medications for Alzheimer s disease DOCUMENT TO BE SCANNED INTO ELECTRONIC RECORDS AND FILED IN NOTES Patient Name : Date of Birth: NHS No: Name
Blood-thinning medication after stroke
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Blood-thinning medication after stroke Blood-thinning medicines are drugs that help to prevent clots forming in your blood. They are often prescribed
Health Plan & Formulary A Simple Resource to Help You Understand Your Benefits. Comparison Guide
Health Plan & Formulary A Simple Resource to Help You Understand Your Benefits Comparison Guide Contents What Does Rx Formulary Mean?... 3 How To Use This Comparison Guide... 3 A Note To Members... 3 Health
UW MEDICINE PATIENT EDUCATION. Xofigo Therapy. For metastatic prostate cancer. What is Xofigo? How does it work?
UW MEDICINE PATIENT EDUCATION Xofigo Therapy For metastatic prostate cancer This handout explains how the drug Xofigo is used to treat metastatic prostate cancer. What is Xofigo? Xofigo is a radioactive
medicineupdate to find out more about this medicine
medicineupdate Asking the right questions about new medicines Seretide for chronic obstructive pulmonary disease What this medicine is 1 What this medicine treats 2 Other medicines available for this condition
Union EMS Local Formulary July 18, 2014
July 18, 2014 Forward The intent of the Union EMS Local Formulary is to provide guidance during the implementation and use of the 2012 NCCEP Protocols, Policies and Procedures to the ALS and BLS Professionals
(TECHNICIANS) 4:30-5:30PM
E5. HIGH RISK PATIENTS, HIGH RISK MEDICATIONS: A FOCUS ON ANTICOAGULATION AND HEART FAILURE (TECHNICIANS) 4:30-5:30PM ACPE UAN: 0107-9999-15-040-L01-T 0.1 CEU/1.0 hr Activity Type: Knowledge-Based Learning
Using WHI Current Medication Data. Jill Shupe May 6, 2009
Using WHI Current Medication Data Jill Shupe May 6, 2009 Current Medications Presentation Outline Data Collection Medi-Span Data Files Examples Current Medication (Form 44) Data Collection When and on
There is a risk of renal impairment in dehydrated children and adolescents.
PACKAGE LEAFLET: INFORMATION FOR THE USER MELFEN 200mg FILM-COATED TABLETS MELFEN 400mg FILM-COATED TABLETS Ibuprofen Read all of this leaflet carefully before you start taking this medicine because it
Galantamine hydrobromide (Reminyl) Drug treatment for Alzheimer s disease
IS 17 October 2011 Information sheet Galantamine hydrobromide (Reminyl) Drug treatment for Alzheimer s disease Introduction... 1 How does Reminyl work?... 1 Who might benefit?... 2 What effect might Reminyl
10/30/2012. Anita King, DNP, RN, FNP, CDE, FAADE Clinical Associate Professor University of South Alabama Mobile, Alabama
Faculty Medications for Diabetes Satellite Conference and Live Webcast Wednesday, November 7, 2012 2:00 4:00 p.m. Central Time Anita King, DNP, RN, FNP, CDE, FAADE Clinical Associate Professor University
product list Put our quality and service behind your brand. 200 Hicks Street, Westbury, NY 11590 +1.516.986.1700
product list We are committed to high quality and expedited service, bringing leading and exclusive products to our customers. Our private label products include a broad range of pharmaceutical categories.
PATIENT HISTORY FORM
PATIENT HISTORY FORM If you are new to the office, have not been seen in over one (1) year, or are returning for a new problem, please complete this form in full. If there have been any changes since your
General Internal Medicine Clinic New Patient Questionnaire
General Internal Medicine Clinic New Patient Questionnaire Date: Name: What would you like to be called by the doctor? Marital Status: Please list how you would like to be contacted, for test results:
Dallas Neurosurgical and Spine Associates, P.A Patient Health History
Dallas Neurosurgical and Spine Associates, P.A Patient Health History DOB: Date: Reason for your visit (Chief complaint): Past Medical History Please check corresponding box if you have ever had any of
Objectives. Aging and Forgetfulness Define Dementia Types of Dementia Treatment
Dementia David Lam, MD, FRCPC, Psychiatry Assistant Clinical Professor Department of Psychiatry and Behavioural Neurosciences McMaster University Hamilton, Ontario Objectives Aging and Forgetfulness Define
AMERICAN BRAIN TUMOR ASSOCIATION. Steroids
AMERICAN BRAIN TUMOR ASSOCIATION Steroids ACKNOWLEDGEMENTS ABOUT THE AMERICAN BRAIN TUMOR ASSOCIATION Founded in 1973, the American Brain Tumor Association (ABTA) was the first national nonprofit organization
Medication Coordination and Coverage in Hospice
Medication Coordination and Coverage in Hospice Alen Voskanian, MD, FAAHPM, AAHIVS Regional Medical Director, VITAS Innovative Hospice Care Assistant Clinical Professor of Medicine, David Geffen School
PATIENT HEALTH QUESTIONNAIRE Radiation Oncology (Patient Label)
REVIEWED DATE / INITIALS SAFETY: Are you at risk for falls? Do you have a Pacemaker? Females; Is there a possibility you may be pregnant? ALLERGIES: Do you have any allergies to medications? If, please
Medicines Used to Treat Type 2 Diabetes
Goodman Diabetes Service Medicines Used to Treat Type 2 Diabetes People who have type 2 diabetes may need to take medicine to help lower their blood glucose, in addition to being active & choosing healthy
Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Beta-blockers Calcium channel blockers Diuretics
Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Beta-blockers Calcium channel blockers Diuretics This brochure gives you information about high blood pressure and
Cardiovascular Risk in Diabetes
Cardiovascular Risk in Diabetes Lipids Hypercholesterolaemia is an important reversible risk factor for cardiovascular disease and should be tackled aggressively in all diabetic patients. In Type 1 patients,
Look in various databases for specific information about drugs.
NAME Summer 2005 Version 1 DRMC NURSE INTERNSHIP LIBRARY TRAINING ASSIGNMENT II Look in various databases for specific information about drugs. 1. What is the recommended dosage regimen for use of reserpine
National Digestive Diseases Information Clearinghouse
Gastritis National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is gastritis? Gastritis is a condition in which the stomach
Clopidogrel Winthrop Plus Aspirin
Aspirin Clopidogrel (clop-id-o(h)-grel) and Aspirin (as-per-in) Consumer Medicine Information What is in this leaflet This leaflet answers some common questions about Clopidogrel Winthrop Plus Aspirin
CBT/OTEP 243 Aspirin Administration for ACS
Seattle-King County EMS Seattle-King County Emergency Medical Services Division Public Health - Seattle/King County 401 5th Avenue, Suite 1200 Seattle, WA 98104 (206) 296-4693 February 2009 CBT/OTEP 243
READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION. sacubitril/valsartan film-coated tablets
READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION Pr ENTRESTO TM sacubitril/valsartan film-coated tablets Read this carefully before you start taking ENTRESTO TM and
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic
HEALTH PLAN & FORMULARY COMPARISON GUIDE. A Simple Resource to Help You Understand Your Benefits
HEALTH PLAN & FORMULARY COMPARISON GUIDE A Simple Resource to Help You Understand Your s Contents PAGE What Does Rx Formulary Mean?....................................3 How To Use This Comparison Guide.................................3
Cardioversion for. Atrial Fibrillation. Your Heart s Electrical System Cardioversion Living with Atrial Fibrillation
Cardioversion for Atrial Fibrillation Your Heart s Electrical System Cardioversion Living with Atrial Fibrillation When You Have Atrial Fibrillation You ve been told you have a heart condition called atrial
VAD Chemotherapy Regimen for Multiple Myeloma Information for Patients
VAD Chemotherapy Regimen for Multiple Myeloma Information for Patients The Regimen contains: V = vincristine (Oncovin ) A = Adriamycin (doxorubicin) D = Decadron (dexamethasone) How Is This Regimen Given?
Medication Review. Cardiovascular Drugs. Pharmacy Technician Training Systems Passassured, LLC
Medication Review Cardiovascular Drugs Pharmacy Technician Training Systems Passassured, LLC Medication Review, Cardiovascular Drugs PassAssured's Pharmacy Technician Training Program Medication Review
Daily aspirin therapy: Understand the benefits and risks
Daily aspirin therapy: Understand the benefits and risks Is an aspirin a day the right thing for you? It's not as easy a decision as it sounds. Know the benefits and risks before considering daily aspirin
PATIENT INFORMATION LEAFLET Phor Migraine (Ibuprofen)
PATIENT INFORMATION LEAFLET Phor Migraine (Ibuprofen) Read all of this leaflet carefully before you start taking this medicine. Keep this leaflet. You may need to read it again. If you have any further
MEDICATIONS COMMONLY USED IN CHRONIC KIDNEY DISEASE. HealthPartners Kidney Health Clinic 2011
MEDICATIONS COMMONLY USED IN CHRONIC KIDNEY DISEASE HealthPartners Kidney Health Clinic 2011 People with chronic kidney disease (CKD) require multiple medications. This handout will help explain the reason
H1N1 Flu Vaccine Available to All Virginia Beach City Public Schools Students
V i r g i n i a B e a c h C i t y P u b l i c S c h o o l s apple-a-day F o r O u r F a m i l y o f I n t e r e s t e d C i t i z e n s Special Edition H1N1 Flu Vaccine Available to All Virginia Beach
FOOD/DRUG AND DRUG/NUTRIENT INTERACTIONS: What You Should Know About Your Medications 1
10 FCS8092 FOOD/DRUG AND DRUG/NUTRIENT INTERACTIONS: What You Should Know About Your Medications 1 Linda B. Bobroff, Ashley Lentz, and R. Elaine Turner 2 Introduction Medications, both prescription and
Lithium. Generic name = lithium carbonate (tablets and capsules), or lithium citrate (liquid)
Lithium Brand and Generic Names Eskalith - Capsules: 300 mg Eskalith CR slow release - Tablets: 450 mg Lithobid slow release - Tablets: 300 mg Generic name = lithium carbonate (tablets and capsules), or
Metoprolol Sandoz Metoprolol tartrate tablets
Metoprolol Sandoz Metoprolol tartrate tablets Consumer Medicine Information WHAT IS IN THIS LEAFLET This leaflet answers some common questions about Metoprolol Sandoz. It does not contain all the available
ANTI-REJECTION MEDICATIONS
ANTI-REJECTION MEDICATIONS Anti-rejection medications suppress your body s natural defence system (immune system) to prevent it from recognizing your transplant as a foreign invader and attacking it. The
Blood-thinning medication after stroke
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Blood-thinning medication after stroke Blood-thinning medicines are drugs that help to prevent blood clots forming. They are often prescribed after
Allergy Shots and Allergy Drops for Adults and Children. A Review of the Research
Allergy Shots and Allergy Drops for Adults and Children A Review of the Research Is This Information Right for Me? This information may be helpful to you if: Your doctor* has said that you or your child
what is warfarin? Treatment with Warfarin (Coumadin ) What is warfarin?
What is warfarin? Warfarin sodium (Coumadin ) is a medication that works as an anti-coagulant. Anti means against and coagulant refers to blood clotting. An anticoagulant helps to prevent clots from forming
Memantine (Ebixa) Drug treatment for Alzheimer s disease
IS 20 October 2011 Information sheet Memantine (Ebixa) Drug treatment for Alzheimer s disease Introduction... 1 How does Ebixa work?... 1 Who might benefit?... 2 What effect might Ebixa have?... 2 How
PREMIER PLASTIC SURGERY CENTER OF NEW JERSEY 310 MADISON AVENUE, SUITE 100, MORRISTOWN, NJ 07960 PHONE: 973-889-9300 FAX: 973-889-9400
PREMIER PLASTIC SURGERY CENTER OF NEW JERSEY 310 MADISON AVENUE, SUITE 100, MORRISTOWN, NJ 07960 PHONE: 973-889-9300 FAX: 973-889-9400 Patient Information as of (todays date). Please print legibly and
MEDICATION GUIDE KOMBIGLYZE XR (kom-be-glyze X-R) (saxagliptin and metformin HCl extended-release) tablets
MEDICATION GUIDE KOMBIGLYZE XR (kom-be-glyze X-R) (saxagliptin and metformin HCl extended-release) tablets Read this Medication Guide carefully before you start taking KOMBIGLYZE XR and each time you get