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Collaborative clinicians
Stephanie Entringer
Created on March 22, 2025
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Collaborative clinicians
From Textbook to treatment: A GI Med Adventure
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Mrs. L, age 73, has chronic GERD. She's on omeprazole and takes calcium carbonate for bone health. She recently fall and fractured her hip. She says she also takes baking soda after meals to help with heartburn.
Case 1 - Mrs. L.
case 1 - mrs. l. - 73 yo f - chronic gerd
Omeprazole
What med class is omeprazole? What's its mechanism?
calcium absorption
What concerns might you have about calcium absorption and her fracture risk?
Patient Education
What should you teach her about long-term PPI use?
baking soda
How would you address her use of baking soda for heart burn?
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If she had chronic kidney disease, which antacid would you avoid?
Would calcium carbonate or calcium citrate be a better choice for this patient? Why?
The patient is also taking iron supplements. How would that affect absorption?
What if?
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Mr. H. is a 55-year-old patient with newly diagnosed H. pylori-associated peptic ulcer disease. he's prescribed amoxicillin, clarithromycin, and a PPI for 14 days. He says, "I'm feeling better after day 4 - can I stop?
Case 2 - Mr. H.
case 2 - Mr. H. - 55 yo m - h. pylori infection
case questions
Why triple therapy?
What is the rationale behind triple therapy?
common side effects?
What are common side effects to warn him about?
why 14 days?
Why must he finish the 14-day course?
medication timing?
What would you teach him about medication timing?
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If the patient develops severe diarrhea during treatment, what condition should you consider?
Why might a provider choose clarithromycin vs. metronidazole?
What complications can arise if the patient stops antibiotics early?
What if?
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Ms. B. has frequent nausea with chemotherapy. She's prescribed ondansetron and scopolamine. She also reports dizziness and asks if she can drive to her appointments.
Case 3 - Ms. B.
case 3 - Ms. b. - chemotherapy enduced nausea and vomiting
When should antiemetics be given in relation to chemo?
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Give antiemetics 30-60 minutes before chemotherapy.
Why are multiple antiemetics sometimes used together?
Multiple antiemetics work better together than alone (synergistic effect).
What teaching should you give about side effects and driving?
What are the mechanisms of ondansetron and scopolamine?
Teach about risk for dizziness and drowsiness. Avoid driving or operating heavy machinery.
Ondansetron blocks serotonin receptors; scopolamine blocks muscarinic receptors.
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If the patient prefers natural remedies, what safe option might you recommend (with provider approval)?
What are signs of serotonin syndrome, and which antiemetic increases that risk?
What's the benefit of using ondansetron instead of promethazine?
What if?
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Mr. J., 60, is taking diphenoxylate with atropine for diarrhea. He calls in saying, "I took more than prescribed, and now my vision is blurring and my heart is racing."
Case 4 - Mr. J.
case 4 - Mr. j. - diphenoxylate with atropine for diarrhea
Question 4
Question 3
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Question 2
Question 1
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Would loperamide be a safer option for long-term use? Why or why not?
What's the antidote for severe anticholinergic toxicity?
What is the most appropriate nursing action in response to the patient's symptoms?
What if?
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You are caring for Mrs. M., a patient with megaloblastic anemia due to B12 deficiency. She is starting IM cyanocobalamin. She also has a history of hypokalemia.
Case 5 - Mrs. M.
Choose a game piece and roll the dice. Answer a question (1–4). If correct, move your piece forward the number of spaces rolled.
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Game Piece:
Beginning