A client with ulcerative colitis has an order to begin salicylate medication to reduce inflammation. The nurse instructs the client to take the medication:
A. 30 minutes before meals
B. On an empty stomach
C. After meals
D. On arising
Correct Answer: C. After meals
Salicylate compounds act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and to increase fluid intake throughout the day. This medication needs to be taken after meals to reduce GI irritation.
Option A: The medication should not be taken 30 minutes before meals. Aspirin absorption from the gastrointestinal (GI) tract depends on the formulation state. When consumed as a liquid preparation, it is rapidly absorbed as opposed to tablets. Its hydrolysis yields salicylic acid. Salicylic acid has a narrow therapeutic window. If maintained within that narrow range, it provides the appropriate anti-inflammatory effect.
Option B: Aspirin, if taken on an empty stomach, may cause GI upset. Aspirins absorption is pH sensitive at the level of the small intestine. Absorption is higher through the small intestine than the stomach for the same pH range. At pH 3.5 or 6.5, aspirin’s intestinal absorption is greater than the gastric absorption of the compound. The stomach does not absorb aspirin at pH 6.5.
Option D: Taking aspirin upon arising may put the client at risk for GI upset. The most common side effect of aspirin is gastrointestinal upset ranging from gastritis to gastrointestinal bleed. Aspirin increases the risk of GI bleeding in patients who already suffer from peptic ulcer disease or gastritis. The risk of bleeding is still present even without these conditions if there is concomitant consumption of alcohol or if the patient is on warfarin.
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