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  • Patient Name: Chris Stewart  DOB: 02/02/19XX

  • Address: 234 Scioto Rd., Columbus, OH 43210  Phone: 614-222-2222

  • Medication Allergies: NKDA

Discharge Summary

Chris Stewart is a pleasant 55-year-old who was admitted to the hospital 2 days ago after presenting with a chief complaint of severe headache and blurred vision. The patient’s BP was found to be 220/118 upon presentation. Ten days prior to hospitalization, the patient stopped taking amlodipine due to peripheral edema and also admits to stopping clonidine approximately 4 days ago. The patient admits to using antihypertensive medications “as needed based on how I feel.” The patient was treated with IV nicardipine to reduce BP gradually. Once near goal, nicardipine was stopped, and the patient was switched to verapamil ER, which was tolerated and will be continued as an outpatient. Home antihypertensives (except clonidine) were continued while inpatient. In place of clonidine, terazosin was initiated at a dose of 1 mg daily while admitted and will be continued upon discharge. The patient received education on the importance of daily adherence to BP medications. At discharge, the patient’s BP is 138/88 and stable. Due to multiple changes, the patient will receive counseling from our pharmacist on med changes prior to discharge.

PMH

HTN, HLD

Vitals/Labs at Discharge

BP 138/88 mmHg, HR 64 bpm, Wt 75 kg, K 4.4 mEq/L, Na 141 mEq/L,

SCr 0.79 mg/dL, BUN 8 mg/dL, Cl 99 mEq/L, CO2 24 mEq/L

Patient medication instructions

STOP taking the following medications

  • Amlodipine (NORVASC) 10 mg

  • Clonidine (CATAPRES) 0.2 mg

START taking the following medications

  • Verapamil ER (CALAN SR) 180 mg, Take one tablet by mouth once daily.

    • Other information: Check and record your blood pressure. Follow up with your PCP about this medication.

  • Terazosin (HYTRIN) 1 mg, Take one tablet by mouth once daily at bedtime.

    • Other information: Check and record your blood pressure and heart rate. Follow up with your PCP about this medication.

CONTINUE these medications, which have NOT changed

  • Atorvastatin (LIPITOR) 40 mg, Take one tablet by mouth once daily.

  • Carvedilol (COREG) 25 mg, Take one tablet by mouth twice daily with food.

  • Hydrochlorothiazide (MICROZIDE) 25 mg, Take one tablet by mouth once daily in the morning.

  • Lisinopril (PRINIVIL) 40 mg, Take one tablet by mouth once daily.

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