Question Index: Medication Use (Prescription and Over-the-Counter)
| Questions
|
Year(s) Asked on Long Forms (Click on year to view PDF of questionnaire.) |
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tagamet (cimetidine) | x | x | x | x | x | x | x | |||||||
| Zantac (ranitidine) | x | x | x | x | x | |||||||||
| Prilosec or Prevacid | x | x | ||||||||||||
| Thyroid hormone (extract, Synthroid) | x | x | x | |||||||||||
| Aldomet (methyldopa) | x | x | ||||||||||||
| Aspirin (includes Bufferin, Anacin, etc.) with days/ month and dose | x | x | x | x | x | x | x | x | x | x | x | |||
| How many aspirin tablets do you take per week? | x | x | x | x | x | |||||||||
| How frequently do you take aspirin? | x | x | x | x | x | |||||||||
| Other non steroidal anti-inflammatory drugs (Circle: Motrin/ Indocin/ Tolectin/ Clinoril/ Alleve/ Naprosyn) | x | x | x | x | x | x | x | x | ||||||
| - days/week | x | |||||||||||||
| Baby/low-dose aspirin & days/week | x | x | ||||||||||||
| Acetominophen | x | x | ||||||||||||
| - days/week | x | x | x | x | x | x | x | |||||||
| Ibuprofen & days/week | x | x | ||||||||||||
| Coumadin | x | x | x | x | x | |||||||||
| Tamoxifen | x | x | x | |||||||||||
| Lasix | x | x | x | x | x | |||||||||
| Steriods taken orally (e.g., Prednisone) | x | x | x | x | x | |||||||||
| Inhaled steroids, bronchodilator | x | x | x | x | ||||||||||
| Celebrex or Vioxx | x | x | ||||||||||||
| Digoxin or Antiarythmic | x | x | x | x | x | |||||||||
| Valium | x | x | x | x | x | x | x | |||||||
| Minor tranquilizers (e.g., Valium, Xanax) | x | x | ||||||||||||
| Thiazide diuretics (Diuril, Hydrodiuril) | x | x | x | x | x | x | x | x | ||||||
| Phenothiazines (eg. Thorazine, Stelazine, Compazine, Mellaril) | x | |||||||||||||
| Tetracycline use (how long?) | x | |||||||||||||
| Griseofulvin by mouth? (duration before or after 1970) | x | |||||||||||||
| Other medications (specify) | x | x | x | x | ||||||||||
| No regular medications | x | |||||||||||||
| How often do you use a laxative? | x | |||||||||||||
| Beta blockers | x | x | x | x | x | x | ||||||||
| Calcium Channel blockers | x | x | x | x | x | x | ||||||||
| Other blood pressure medication | x | x | x | x | x | x | ||||||||
| ACE inhibitors | x | x | x | x | x | |||||||||
| Insulin | x | x | x | x | x | |||||||||
| Oral diabetic medication | x | x | x | x | ||||||||||
| Oral hypoglycemic medication | x | x | x | |||||||||||
| Cholesterol lowering drugs | x | x | x | x | ||||||||||
| "Statin" cholesterol lowering drugs (e.g., Mevacor, Zocor) and years of use | x | x | ||||||||||||
| "Other" cholesterol lowering drugs | x | x | ||||||||||||
| Antidepressant | x | x | ||||||||||||
| Prozac | x | x | ||||||||||||
| Zoloft | x | x | ||||||||||||
| Paxil | x | x | ||||||||||||
| Celexa | x | x | ||||||||||||
| Other antidepressant | x | x | ||||||||||||
| Meridia (sibutramine) | x | x | x | |||||||||||
| Phentermine | x | x | ||||||||||||
| Xenical | x | x | ||||||||||||
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