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Could this Lasix dose be correct?

Posted By: help needed on 2007-04-16
In Reply to:

Does Lasix 380 mg twice daily sound excessive?  The doctor originally dictated 20 mg daily and then went back and had me change it.  I saw something about a dose can be titrated up carefully to 600 mg daily with patients with severe edematous conditions........just not sure.  Any help would be greatly appreciated!!!


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There are three sliding-scale insulin regimens - mild dose, moderate dose, and high dose.
Subject: There are three sliding-scale insulin regimens - mild dose, moderate dose, and high dose.

So mild is correct.
target dose is correct. SM
Subject: target dose is correct. SM

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Duh, make that dose is correct. Sorry. nm
Subject: Duh, make that dose is correct. Sorry. nm


Does Reglan 0.5 mg p.o. q.6h. sound like a correct dose for newborn who underwent heart surgery? sm
Subject: Does Reglan 0.5 mg p.o. q.6h. sound like a correct dose for newborn who underwent heart surgery? sm

It sounds like doc is clearly stating 0.5 mg, but I can't verify in my drug book or google.


Thanks and Merry Christmas!


patient received a single dose of radioactive iodine. The dose in S/L milliequaries? is unknown?
Subject: patient received a single dose of radioactive iodine. The dose in S/L milliequaries? is unknown?

NM
Looks like Lasix 40 mg PRN sm
Subject: Looks like Lasix 40 mg PRN sm

Lasix (furosemide) is given for CHF and edema. Sometimes patients alternate it as needed for their legs etc. Just a thought.
It could be K-Dur which is taken with Lasix.
Subject: It could be K-Dur which is taken with Lasix.


WAG could it be Lasix 80 mg q.d. x7 days
Subject: WAG could it be Lasix 80 mg q.d. x7 days


Usually when a patient takes antihypertensives like Lasix, they will sm
Subject: Usually when a patient takes antihypertensives like Lasix, they will sm

need potassium, too. I'm thinking that maybe what you're hearing is Lasix (comma), then maybe potassium chloride? Don't know about the 3rd.
Agree. No plural for Tylenol or Lasix or any other drug. nm
Subject: Agree. No plural for Tylenol or Lasix or any other drug. nm

nope
does not give. Listed with other meds Coumadin, metoprolol, Lasix, Synthroid, calcon, potassium. nm
Subject: does not give. Listed with other meds Coumadin, metoprolol, Lasix, Synthroid, calcon, potassium. nm

nm


guessing "two more dose" protocol, or even "tumor dose" protocol. sm
Subject: guessing "two more dose" protocol, or even "tumor dose" protocol. sm

If either one ties in with the patient's history, etc.


No dose
Subject: No dose

No dose and he does list aspirin as well. 


Thanks for helping out  


That is the max dose as per the sm
Subject: That is the max dose as per the sm

Monthly Prescribing Reference.


dose of?
Subject: dose of?


It comes in 17 gm. Could be dose? nm
Subject: It comes in 17 gm. Could be dose? nm

nm
what is the dose? nm
Subject: what is the dose? nm


1/2 cap ful per day? 1 cap is dose also. nm
Subject: 1/2 cap ful per day? 1 cap is dose also. nm


1-g-b.i.d. dose?
Subject: 1-g-b.i.d. dose?

Is this correct or should I take the hypens out?  I assume this is correct, but it looks funny to me.


. . . all of which can cause stomach upset, expecially the metformin in a 1-g-b.i.d. dose. 


Thanks.


dose is 250 per 5 mL most likely. nm
Subject: dose is 250 per 5 mL most likely. nm


Oh no dose?
Subject: Oh no dose?

The doc dictates "oh no dose p.r.n." Is that 0.no dose p.r.n.? Your thoughts please and thanks.
not metered dose
Subject: not metered dose

nope--he is definitely saying med neb, as in "I ordered another one-hour med neb treatment."  He says it several times throughout the dictation.  I have heard this before, but it has been a long time, and I cannot remember how to transcribe it.  Thanks though!
s/l Doe dose see mssg
Subject: s/l Doe dose see mssg

ASSESSMENT/PLAN 


1.      Thyroid carcinoma – a TSH and free T4 have been requested.  Review of laboratory studies requested by Dr. X in June of 2005 demonstrated an elevated TSH level at 8.  Apparently s/l DOE DOSE adjustment was made.  We will need to discuss thyroid suppression and goal of TSH with Dr. x.    She is due for thyroid scan.


 


It is definately not low dose.  It sounds like doe dose.  Am i missing something ???


that's much too high of a dose
Subject: that's much too high of a dose

nm
Sorry. I keep thinking that with that 400 mg dose sm
Subject: Sorry. I keep thinking that with that 400 mg dose sm

it might be an antibiotic for UTI etc?  Here is a list of some antibiotics in that dosage. Good luck. All I can offer for this one!!


 


http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/antibiotic%20costs.htm


dose of med. Dr. says digoxin 215 mcg a day??
Subject: dose of med. Dr. says digoxin 215 mcg a day??


Could it be ~dose~ intensity? sm
Subject: Could it be ~dose~ intensity? sm

See link to reference


maybe...low-dose aspirin
Subject: maybe...low-dose aspirin


Is there a dose for prednisone given as cc? sm
Subject: Is there a dose for prednisone given as cc? sm

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Zanaflex has 2-mg dose
Subject: Zanaflex has 2-mg dose


do you have a dose or any idea what it is taken for? nm
Subject: do you have a dose or any idea what it is taken for? nm


do you have a dose or any more info? nm
Subject: do you have a dose or any more info? nm


Maybe just "...and takes a...." since that same med comes in that dose. nm
Subject: Maybe just "...and takes a...." since that same med comes in that dose. nm

nm
Sorry. I am stumped. What is the dose. nm
Subject: Sorry. I am stumped. What is the dose. nm


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Subject: Renagel dose

comes in 400 mg and 800 mg... Had a report a few weeks back where the doctor dictated "5600 mg" of Renagel.  Was not sure so sent to QA for another pair of ears.  They changed it to 600 mg which does not sound like a possible dose. Is Renagel sometimes taken in such large doses?
Are you sure it's not atacand (dose 16, not 60)? NM
Subject: Are you sure it's not atacand (dose 16, not 60)? NM


Are you sure it's not Atacand (dose 16, not 60)? NM
Subject: Are you sure it's not Atacand (dose 16, not 60)? NM


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Subject: Probably Pravastatin but dose...sm

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Medrol dose-pack
Subject: Medrol dose-pack

According to Quick Look Drug Book 2005 - Medrol dose-pack
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Subject: O2 saturation--post dose?

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Could it be Ansaid? Dose fits nm
Subject: Could it be Ansaid? Dose fits nm

x
I would flag it, 5 mg b.i.d. is not a normal dose
Subject: I would flag it, 5 mg b.i.d. is not a normal dose

Here's some info copied and pasted from my QuickLook drug reference.  It looks like 4 mg a day total is about the highest dose.




Usual Dosage

Oral: Note: Treatment >4 months should be re-evaluated to determine the patient's continued need for the drug
Adults:
Anxiety: Immediate release: Effective doses are 0.5-4 mg/day in divided doses; the manufacturer recommends starting at 0.25-0.5 mg 3 times/day; titrate dose upward; maximum: 4 mg/day
Anxiety associated with depression: Immediate release: Average dose required: 2.5-3 mg/day in divided doses
Panic disorder:
Immediate release: Initial: 0.5 mg 3 times/day; dose may be increased every 3-4 days in increments ≤1 mg/day; many patients obtain relief at 2 mg/day, as much as 10 mg/day may be required
Extended release: 0.5-1 mg once daily; may increase dose every 3-4 days in increments ≤1 mg/day (range: 3-6 mg/day)
Switching from immediate release to extended release: Patients may be switched to extended release tablets by taking the total daily dose of the immediate release tablets and giving it once daily using the extended release preparation.
Preoperative sedation: 0.5 mg in evening at bedtime and 0.5 mg 1 hour before procedure
Dose reduction: Abrupt discontinuation should be avoided. Daily dose may be decreased by 0.5 mg every 3 days, however, some patients may require a slower reduction. If withdrawal symptoms occur, resume previous dose and discontinue on a less rapid schedule.



Dosage Forms


Solution, oral (Alprazolam Intensol®): 1 mg/mL (30 mL)
Tablet (Xanax®): 0.25 mg, 0.5 mg, 1 mg, 2 mg
Tablet, extended release (Xanax XR®): 0.5 mg, 1 mg, 2 mg, 3 mg
Tablet, orally-disintegrating (Niravam™): 0.25 mg, 0.5 mg, 1 mg, 2 mg [orange flavor]

Is Xanax 5 mg b.i.d. a customary dose of this?
Subject: Is Xanax 5 mg b.i.d. a customary dose of this?

Just wondering, I am used to transcribing 0.5 mg or 1 mg, 2 mg at the most but I have a resident saying 5 mg b.i.d.  I'm not a doctor so I don't want to pretend I know better, but would you flag this to be sure it was 5 and not 0.5 if you were me?   Maybe they do prescribe as high as 5 mg and just because I have never typed that high of a dose doesn't mean anything, but I always worry, same as when they dictate mg for something that I'm used to typing mcg.  Any opinions?
MDI is metered-dose inhaler nm
Subject: MDI is metered-dose inhaler nm

nm
Quick Look does show it as an IV dose (sm)
Subject: Quick Look does show it as an IV dose (sm)

Benadryl® Injection  I.M., I.V.: 10-50 mg in a single dose every 2-4 hours, not to exceed 400 mg/day.


However, fentanyl would be more common in an OP note (at least that has been my experience) and could kinda sort sound like Benadryl).  Did they give any dosage?

fentanyl - Preoperative sedation, adjunct to regional anesthesia, postoperative pain: I.M., I.V.: 50-100 mcg/dose


Could be Amaryl at that dose.They titrate it up by 2 mg and could be just what sm
Subject: Could be Amaryl at that dose.They titrate it up by 2 mg and could be just what sm

the patient had to make up 5 mg, Max dose is 8 mg as per MPR.
Nitroglycerin dose question
Subject: Nitroglycerin dose question

Has anyone heard of a nitroglycerin dosage being one 150 or 1-150?  I am unsure how to type that.  Thanks.