Gastritis, PUD, and GERD: Antibiotics, Mucosal Protectants, and Prokinetic Agents (Nursing)

00:01 Finally, let’s discuss the use of antibiotics in treating gastritis, which we already know it’s mostly caused by H.

00:08 pylori. Now, the first antibiotic we're gonna discuss is clarithromycin.

00:13 Now, this antibiotic works by inhibiting protein synthesis in H.

00:16 pylori bacteria.

00:17 Although, keep in mind, the resistance rates are on the rise for clarithromycin.

00:23 Now, the common side effects of clarithromycin include nausea, diarrhea, and taste distortion. Next up, we have amoxicillin.

00:32 Now, this antibiotic targets H.

00:34 pylori by disrupting its bacterial cell wall.

00:37 It has a low resistance rate, making it a valuable choice.

00:41 So, combining amoxicillin with antisecretory agents, like omeprazole, can enhance the effectiveness of the treatment plan. The most common side effect of amoxicillin is diarrhea.

00:54 Bismuth compounds also play a role in treating H.

00:57 pylori infections.

00:58 They work by disrupting the bacterial cell wall, leading to bacterial cell death, and inhibiting urease activity and bacterial adherence to the gastric surface.

01:08 Keep in mind that bismuth can cause a harmless black coloration of the tongue and stool, so please inform your patients of this possibility.

01:17 Tetracycline is another antibiotic highly active against H.

01:21 pylori. Now it inhibits the bacterial protein synthesis.

01:24 Resistance to Tetracycline is rare.

01:26 However, it's not recommended for pregnant women or young children due to potential tooth staining. Lastly, metronidazole is effective against some H.

01:37 pylori strains, that are still sensitive to metronidazole, but remember, resistance rates are over 40%.

01:45 Common side effects include nausea and headache and it's important to avoid using metronidazole during pregnancy and with alcohol, as it can cause a disulfiram-like reaction. Now, let's look at mucosal protectants.

02:03 Mucosal protectants such as sucralfate, colloidal bismuth compounds, or misoprostol, play a crucial role in facilitating the healing process and providing symptom relief because they form this sticky gel-like coating over the damaged mucosal surfaces in the GI tract. Now, this physical barrier prevents further injury from gastric acid and this allows the underlying tissue to heal and recover.

02:24 Now, there are a couple of side effects we need to keep in mind when using mucosal protectants. So, these are things like constipation, that's sucralfate, diarrhea - misoprostol - darkened stools or tongue - bismuth subsalicylate -, nausea, and abdominal pain or cramps across the board. Lastly, it's essential to consider drug interactions when you're giving mucosal protectants.

02:48 Some notable interactions that we need to keep in mind are that: Sucralfate and bismuth subsalicylate may reduce the absorption of certain medications.

02:57 For this reason, it's advisable to take these medications at least 2 hours before or after sucralfate. And finally, misoprostol can increase the risk of bleeding when taken with anticoagulants or antiplatelet agents.

03:11 So up to this point, we have discussed antacids, H2-receptor antagonists, Proton pump inhibitors, antibiotics, and mucosal protectants.

03:20 Now, there is one more group of drugs, I wanna bring to your attention, these are prokinetic agents.

03:25 To understand the mechanism of action of prokinetic agents such as mosapride citrate or itopride, we need to remember what we discussed earlier about the lower esophageal sphincter. So, when the lower esophageal sphincter becomes weak, stomach acid can flow back into the esophagus, leading to damage.

03:44 To prevent this damage, we wanna keep the lower esophageal sphincter contracted to stop acid from entering the esophagus.

03:52 Prokinetic agents like mosapride citrate and itopride can help by increasing the LES pressure, that helps the sphincter to contract and keep the stomach acid out of the patient's esophagus.

04:05 Mosapride citrate and itopride both help improve stomach and esophageal muscle contractions, but they do so in different ways.

04:13 Mosapride citrate affects two types of serotonin receptors (5-HT4 and 5-HT3), while itopride acts on dopamine - or D2 - receptors and blocks an enzyme called acetylcholine esterase. These medications can have similar side effects, such as stomach pain, diarrhea, headaches, dizziness, and sleepiness.

04:36 However, it's essential to know that they can interact with different medications.

04:40 Mosapride might not mix well with certain antifungals, also it doesn't mix well with antibiotics like macrolides and some antidepressants.

04:49 On the other hand, itopride could interact with antipsychotics and specific Parkinson's drugs. Always check with a healthcare provider before combining medications! And there you have it! We've covered all the essential drugs for gastritis, peptic ulcer disease, and GERD that you need to know to excel in your exams and in professional practice. Best of luck, and I hope to see you soon in the next video!