Report severe or persistent constipation or signs of obstruction.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client taking sucralfate for a duodenal ulcer also needs an antacid. What does the nurse teach about timing?
Answer: A. Sucralfate forms a protective barrier in an acidic environment and is given on an empty stomach; antacids should be separated by about 30 minutes so they do not interfere with sucralfate binding. Taking them together reduces effectiveness.
Question 2 of 3
A client is taking sucralfate for a duodenal ulcer. Which instruction is most important for the nurse to provide?
Answer: B. Sucralfate forms a protective barrier over the ulcer in an acidic environment and should be taken on an empty stomach, 1 hour before meals and at bedtime. Other oral medications and antacids should be separated by about 30 minutes to 2 hours because sucralfate can bind them and reduce absorption. Crushing is not required and it should not be taken with antacids simultaneously. Taking it with each bite of food reduces its effectiveness.
Question 3 of 3
A client with a peptic ulcer caused by Helicobacter pylori is prescribed triple therapy. Which combination reflects standard H. pylori eradication treatment?
Answer: B. Standard first-line triple therapy for H. pylori is a proton pump inhibitor plus two antibiotics, commonly clarithromycin and amoxicillin (or metronidazole if penicillin-allergic), for 10 to 14 days. A single antibiotic promotes resistance and is inadequate. Antacids alone, or sucralfate plus an antacid, do not eradicate the organism. Combining a PPI with two antibiotics is the evidence-based regimen.
Keep the streak going with more questions like these, each with a full rationale.
What is sucralfate?
It is used for duodenal and gastric ulcers and stress-ulcer prevention. Memory aid: it acts like a 'bandage' that coats the ulcer rather than reducing acid.
Key points to remember
- Coats ulcerated tissue to protect it from acid, pepsin, and bile.
- Requires an acidic environment to activate, so it is given on an empty stomach 1 hour before meals and at bedtime.
- Antacids, H2 blockers, and PPIs should be separated by at least 30 to 60 minutes because they reduce its activation.
- Constipation is the most common side effect.
- Binds many drugs (digoxin, phenytoin, fluoroquinolones, levothyroxine, warfarin), reducing their absorption.
- Minimal systemic absorption, so it has few systemic effects.
Signs & symptoms
- Constipation most common
- ↑ fluid & fiber to prevent it
Nursing priorities
- Give on an empty stomach 1 hour before meals and at bedtime.
- Separate other oral medications by at least 2 hours to prevent binding.
- Separate from antacids by at least 30 minutes.
- Monitor bowel pattern and treat constipation.
- Assess for relief of epigastric pain and ulcer healing.
Patient teaching
- Take on an empty stomach, 1 hour before meals and at bedtime.
- Take other medicines at least 2 hours apart from this drug.
- Increase fluids and fiber to prevent constipation.
- Do not take antacids within 30 minutes of this medication.
Red flags: report now
- Report severe or persistent constipation or signs of obstruction.
- Report reduced effect of other drugs (e.g., bleeding or clotting changes on warfarin) from impaired absorption.
References
Clinical references for this topic
