又被質疑不會看 TINEA？
發表於 : 週五 9月 02, 2011 1:45 pm
病歷
1519 Gastric Ca
250 DM
438 old CVA
4019 HTN
2904 dementia
1105 tinea coporis
A patient in a longterm care facility
A hix of vascular dementia, dm, HTN, and left cerebral stroke , gastric Ca with meta
Skin rash with erythematous margin over all back
NG insertion
NE: right hemiplegia, global aphasia, contracture of lower limb
97/10 A1c: 8.9 ………. 00/04 A1c:8.9
BP:132/78
Medication
Capoten 25mg bid *14 day capoten 被砍14#
Primperan 5mg tid
Novomix 20/12 U bid H
Amlobin 5mg qd
Tuan 1 tube 被砍
申覆如下
鄧陳0 0 是一位78歲女性. 原本有CVA, DM, HTN, 住在新北市萬里一家安養機構
在100/05/15-100/05/30 住院診斷為
1. Gastric Ca with meta
2. UTI
3. DM
4. Hypertension
5. Hyponatremia
6. Anemia
7. Tinea Corporis
Capdon (Captopril)25mg 1# bid/AC *14 day 被核刪為 1# Qd/ac *14 day
不知是何原因?
此患者使用此藥物的原因是
1. 患者有DM. HTN 所以用ACEI 的藥物為首選
2. 患者有NG, Captopril 為短效藥物適合磨粉
3. Captopril 使用需 25mg bid or tid
4. Captopril 為ACEI 藥物中 藥價最低的藥品
綜合以上理由. 敬請給付 Capdon 25mg bid/AC * 14 day
Captopril
適應症
Mild to severe hypertension, CHF, post-MI.
用量
Hypertension Initially 25 mg bid or tid. Dose should not exceed 50 mg tid. Heart failure (in conjunction with usual dose of diuretic & digitalis) Starting dose: 6.25 mg or 12.5 mg tid. Increase dose as required to 50 mg tid. Max: 450 mg daily. Post MI Initially 6.25 mg bid, followed by 12.5 mg tid. Then increase to 25 mg tid over several days, followed by a recommended target dose of 50 mg tid as tolerated
Tuan 是antifungal agent
1. 患者於100/05/15-100/05/30 住院時. 經皮膚科會診為 Tinea corporis. 出院時.並未完全治癒
2. 患者於100/06/02 於安養機構(有事先健保局核准)就診時.背部依然有黴菌感染的現象. 所以開立Tuan (antifungal agent)並無不可.且病歷上均有紀載
3. 若真需皮膚科醫生才能開立. 患者得坐救護車才能到醫院. 費時費力又費錢. 非病患之福而是病患之苦. 因此. 本於醫者父母心. 在情理上. 開立Tuan (antifungal agent)並無不可
不知核刪理由為核?
綜合以上理由. 敬請給付
1519 Gastric Ca
250 DM
438 old CVA
4019 HTN
2904 dementia
1105 tinea coporis
A patient in a longterm care facility
A hix of vascular dementia, dm, HTN, and left cerebral stroke , gastric Ca with meta
Skin rash with erythematous margin over all back
NG insertion
NE: right hemiplegia, global aphasia, contracture of lower limb
97/10 A1c: 8.9 ………. 00/04 A1c:8.9
BP:132/78
Medication
Capoten 25mg bid *14 day capoten 被砍14#
Primperan 5mg tid
Novomix 20/12 U bid H
Amlobin 5mg qd
Tuan 1 tube 被砍
申覆如下
鄧陳0 0 是一位78歲女性. 原本有CVA, DM, HTN, 住在新北市萬里一家安養機構
在100/05/15-100/05/30 住院診斷為
1. Gastric Ca with meta
2. UTI
3. DM
4. Hypertension
5. Hyponatremia
6. Anemia
7. Tinea Corporis
Capdon (Captopril)25mg 1# bid/AC *14 day 被核刪為 1# Qd/ac *14 day
不知是何原因?
此患者使用此藥物的原因是
1. 患者有DM. HTN 所以用ACEI 的藥物為首選
2. 患者有NG, Captopril 為短效藥物適合磨粉
3. Captopril 使用需 25mg bid or tid
4. Captopril 為ACEI 藥物中 藥價最低的藥品
綜合以上理由. 敬請給付 Capdon 25mg bid/AC * 14 day
Captopril
適應症
Mild to severe hypertension, CHF, post-MI.
用量
Hypertension Initially 25 mg bid or tid. Dose should not exceed 50 mg tid. Heart failure (in conjunction with usual dose of diuretic & digitalis) Starting dose: 6.25 mg or 12.5 mg tid. Increase dose as required to 50 mg tid. Max: 450 mg daily. Post MI Initially 6.25 mg bid, followed by 12.5 mg tid. Then increase to 25 mg tid over several days, followed by a recommended target dose of 50 mg tid as tolerated
Tuan 是antifungal agent
1. 患者於100/05/15-100/05/30 住院時. 經皮膚科會診為 Tinea corporis. 出院時.並未完全治癒
2. 患者於100/06/02 於安養機構(有事先健保局核准)就診時.背部依然有黴菌感染的現象. 所以開立Tuan (antifungal agent)並無不可.且病歷上均有紀載
3. 若真需皮膚科醫生才能開立. 患者得坐救護車才能到醫院. 費時費力又費錢. 非病患之福而是病患之苦. 因此. 本於醫者父母心. 在情理上. 開立Tuan (antifungal agent)並無不可
不知核刪理由為核?
綜合以上理由. 敬請給付