Rufus Leanard, a 55-year-old female, was admitted to Hend Ratal/creek Hospital with chest pain on exertion and underwent NSTEMI by enzymes peaking on 8/21/04 with CK 381 and TNI 0.18. She was transferred to Woduatesit General Hospital for catheterization and possible CABG, with her medical history including hypertension, diabetes mellitus, insulin therapy, dyslipidemia, COPD, bronchodilator therapy, asthma, class II angina, class II heart failure, and family history of coronary artery disease. Her physical exam showed carotid 2+ bilaterally, femoral 2+ bilaterally, radial 2+ bilaterally, and dorsalis pedis present by Doppler bilaterally. Laboratory data showed WBC 9.58, hematocrit 30.9, hemoglobin 10.7, platelets 287, PT 13.6, INR 1.0, PTT 36.9, sodium 138, potassium 3.9, chloride 103, CO2 26, BUN 16, creatinine 0.7, glucose 164. Cardiac catheterization data from 3/0/04 showed coronary anatomy, 95% osteo LAD, 40% proximal LAD, 60% proximal ramus, 90% mid circumflex, 90% mid OM1, and right dominant circulation. Preoperative medications included Verapamil 80 mg b.i.d., Avapro 150 mg q.d., aspirin 325 mg q.d. IV heparin, hydrochlorothiazide 50 mg q.d., albuterol 2 puffs b.i.d., fluticasone 2 puffs q.i.d., atorvastatin 10 mg q.d., Celexa 20 mg q.d., ibuprofen 800 mg b.i.d., and NPH insulin 30 units b.i.d. Rufus Leanard underwent an AVR with a 21 Carpentier-Edwards pericardial valve and a CABG x3 LIMA to LAD, SVG1 to PDA, SVG2-OM2 with a Robichek closure, with a bypass time of 201 minutes and a crossclamp time of 156 minutes. On CPB, the patient had severe calcification and adhesions between heart and pericardium, with no complications. Postoperatively, Rufus Leanard was extubated without difficulty and had reasonable saturations on nasal cannula, with chest x-ray appearing wet and diuresis increased. The history of COPD and preoperative COPD medications were restarted, she was in sinus rhythm with a systolic blood pressure of 110 and started on beta-blocker, and given Toradol initially for pain and Percocet for break through pain, with oxygen delivered via nasal cannula at 96% saturation with 3 liters. Postoperative echocardiogram showed an ejection fraction of 55-60%, trace MR, trace TR, no AI, and no regional wall motion abnormalities. Discharge medications included Enteric-coated aspirin 325 mg q.d., Lasix 600 mg q.6h p.r.n. pain, Lopressor 50 mg t.i.d., niferex 150 150 mg b.i.d., simvastatin 20 mg q.h.s., K-Dur 30 mEq b.i.d. and then 20 mEq b.i.d., fluticasone 44 mcg inhaled b.i.d., levofloxacin 500 mg q.d. for 2 days to complete course for UTI, Humalog, insulin on sliding scale, Humalog insulin 12 units subq with breakfast, Humalog insulin 16 units subcutaneous with lunch and dinner, Humalog insulin 62 units subcutaneous q.h.s., and Combivent 2 puffs inhaled q.i.d., Nexium 20 mg q.d., and Lantus insulin 60 mg b.i.d. for 3 days then 40 mg b.i.d. for 3 days, ibuprofen 600 mg q.6h p.r.n. pain. Follow-up appointments were made with Dr. Feder, Dr. Burkhead, and Dr. Saltmarsh, with instructions to make all follow up appointments, wash all wounds daily with soap and water, and watch for signs of infection.
How often does the patient take celexa
atorvastatin 10 mg q.d., Celexa 20 mg q.d., ibuprofen 800 mg b.i.d.,